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INTRODUCTION: Chikungunya is a contagious disease caused by Chikungunya virus, an arbovirus from the Togaviridae family. This infection is mostly spread by mosquitoes from the genus Aedes, especially Aedes albopiclus, which have spread from Asia to America and Europe including some countries surrounding Serbia. EPIDEMIOLOGIC FEATURES: The outbreak of epidemics has been reported in Philippines, Sumatra, Java, Indonesia, West Africa region (from Senegal to Cameroon), Congo, Nigeria, Angola, Uganda, Guinea, Malawi, Central African Republic, Burundi, South Africa and India. At the beginning of the 21st century, large outbreaks were recorded on the island of Réunion. During 2006, 1.400.000 cases of chikungunya infection were recorded in India. Local transmission of infection in continental Europe was reported from Northeast Italy (254 suspected and 78 laboratory confirmed cases in Emilia-Romagna region) and France (two cases in 2010). From December 2013 to June 2014, 5.294 confirmed cases and more than 180.000 suspected cases of chikungunya were reported in the Caribbean. CLINICAL FINDINGS: The disease presents suddenly with fever, rush and arthralgia. In general, chikungunya is a mild self - limited disease. Less often, it may be presented with signs of meningoencephalitis or fulminant hepatitis, sometimes with fatal outcome. CONCLUSION: Fast developing international traffic and booming tourism as well as the vector spreading from its homeland make chikungunya a real threat to our country.

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BACKGROUND/AIM: West Nile virus (WNV) is a neurotropic RNA virus particle which belongs to the Flaviviidae family, genus Flavivirus. It is sustained in arthropods within the transmission cycle between the mosquitoes and birds. Most commonly (80% of cases) WNV infections are asymptomatic among people. Less than 1% of patients develop neuroinvasive forms of the disease--meningitis, encephalitis, or acute flaccid paralysis. The aim of the research was to determine most common clinical and laboratory manifestations, to emphazise the presence of comorbidities and outcomes of treatment among patients with WNV infection. METHODS: This retrospective study, which was conducted in the period from January 1, 2012 to December 31, 2013, evaluated 32 patients who were diagnosed with WNV infection based on clinical findings, laboratory, and serological tests. To assess statistical significance we used χ2, and t-test. RESULTS: The study involved 22 (69%) males and 10 (31%) females aged from 31 to 65 years. On admission, there were 16 (50%) febrile individuals, 27 (84.4%) with positive meningeal signs, 17 (53.2%) with pathological neurological signs, and 10 (31.3%) with consciousness disorders. WNV infection was confirmed by the method enzyme linked immuno sorbent assay (ELISA) in all the patients, while Reverse Transcription Polymerase Chain Reaction (RT-PCR) test was positive in 3 (30%) of the tested patients. Cardiovascular comorbidities dominated in 7 (21.9%) of the cases. Full recovery was accomplished in 87.5% of the cases. CONCLUSION: The results of our study show that the absence of meningeal signs and fever on the day 7 of hospital treatment are indicators of good course and prognosis of neuroinvasive forms of WNV infection. Comorbidities do not increase the risk of disease. ELISA test is a sovereign diagnostic method. In most cases, after the administered symptomatic therapy, the complete recovery of patients was achieved.

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AIM: To determine immediate risk factors of developing tuberculous meningitis, to assess the practical importance of clinical signs and findings in the cerebrospinal fluid (CSF) when opting for the specific therapy, and to predict the outcome of disease in relation to the beginning of treatment. METHODS: A retrospective clinical case series of nine patients with tuberculous meningitis who were treated from April 2001 until November 2010 at the Department of Infectious Diseases in Novi Sad, Serbia was presented. Data of patients' medical records and presentation of clinical and laboratory features, neuroradiologicalfindings and outcome were used. RESULTS: The factors of immediate risk/predisposition for the development of tuberculous meningitis were found in two (22.2%) patients. The duration of symptoms prior to admission was 9 days on average (from 3 to 20 days). The most frequent symptoms on admission were headache and fever in eight (88.9%) patients, whereas two patients (22.2%) were presented with stiff neck and photophobia. Consciousness was preserved in six patients (66.7%), two patients were somnolent and one was in coma. Two(22.2%) patients had concurrent pulmonary tuberculosis. Neuroradiological signs of the disease were present in two patients. CONCLUSION: The duration of symptoms before admission, clinical examination and CSF analysis can be helpful in identifying patients who are at high risk of developing tuberculous meningitis.

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INTRODUCTION: The aim of this study was to determine the percentage of seropositive pregnant women, i.e. of pregnant women infected with Toxoplasma gondii in order to provide an insight into the risk of developing congenital toxoplasmosis in our community. MATERIAL AND METHODS: In the period of two years, 662 pregnant women from Vojvodina were examined serologically. The enzyme-linked immunosorbent assay tests were performed to determine IgM and IgG antibodies against Toxoplasma gondii and the complement fixation test was done to detect total antibodies against Toxoplasma gondii. RESULTS AND DISCUSSION: Seropositivity was determined in 180 pregnant women (27.19%). Of 135 pregnant women examined in the routine control in pregnancy, 16.30% were seropositive and out of five proven, completely new Toxoplasma gondii intfections, three were detected in pregnant women who had undergone the routine check-up for no specific symptoms. A detailed analysis of the frequency of seropositive findings in relation to clinical diagnoses and the place of residence of pregnant women (urban and rural areas) was performed. At the same time, the results from the serological reactions were presented, commented and interpreted, and recommendations were given for the implementation of additional examinations (eg, IgG antibody avidity test) in order to make the accurate diagnosis. CONCLUSION: It can be concluded that the occurrence of congenital toxoplasmosis is still a problem in our community and that the best prevention is the prompt and adequate examination of pregnant women for the presence of Toxoplasma gondii infection.

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BACKGROUND/AIM: The Serbian health system does not have strict guidelines for the treatment of bacterial infections. The choice of treatment is empirical which is not necessarily the same compared to the treatment guidelines from countries with a developed pharmacotherapeutic practice. In this study we compared the difference between the current treatment and the treatment taking into account the latest pharmacotherapeutic and pharmacoeconomic guidelines in order to estimate clinical efficiency of antibacterial drugs that were given as a therapy of urinary tract infections and to evaluate pharmacoeconomic aspect of this therapy as well. METHODS: Our study included 100 patients that were randomly chosen and divided into 2 groups. The first group was treated in an ordinary way, while the second one was treated strictly in accordance with the guidelines (British National Formulary - BNF, and Senford Guide). In both groups of the patients we compared length of hospitalization, combination of the used antibiotics, progress as a whole in clinical picture, laboratory analyses and the price of the whole treatment. RESULTS: Analyzing these values independently and according to statistical tests we proved that there were no significant differences between two groups with regard to the progress in a clinical picture as a whole and the length of hospitalization. According to this analysis, however suggested treatment based on guidelines showed a saving of 34.48% in comparison with the usual system of therapy. CONCLUSION: Efficacy of current treatment of urinary tract infection and the treatment according to foreign guidelines is the same, but the costs of the treatment are lower if the guidelines of developed health care systems are applied.

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INTRODUCTION: Rash can be one of the symptoms in acute infectious mononucleosis. According to the classical literature sources, drug-induced rash can be associated with synthetic penicillin and Epstein-Barr virus itself Nowadays, a lot of case reports point to the development of rash after the administration of other groups of antimicrobials. Clinical and laboratory signs and the administration of antimicrobials in acute Epstein-Barr virus infection have been correlaed with the development of rash. MATERIAL AND METHODS: This retrospective-prospective study (2007-2010) included 243 patients hospitalized for acute infectious mononucleosis at the Department for Infectious Diseases, Clinical Center of Vojvodina, of whom 51 had rash and 192 were without it. Epstein-Barr virus infection was confirmed by ELISA IgM EBV VCA in all patients. RESULTS: Student's t-test did not show a significant difference between the age, gender, duration of symptoms, leucocytes count, absolute lymphocytes count, alanine aminotransferase, aspartate aminotransferase among patients with or without rash. Chi2 test did not show a significant difference among the patients treated by synthetic or pure penicillin, macrolids and 1st and 2nd generation cephalosporins. However, if we compare all these antimicrobials, there is a significant difference between them and 3rd generation cephalosporins. Only two patients developed rash without antimicrobials. CONCLUSION: According to our results, rash developed independently of the clinical course of disease. Previous conclusion that synthetic penicillin produces rash seems to be not true, because there are many patients who were treated with them but did not develop rash. All antimicrobials can be associated with rash, but 3rd generation cephalosporins seem to produce rash less frequently than the others.

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INTRODUCTION: Not so long ago, back in the 1900s, infectious diseases were the leading cause of death world wide. The doubling of our life span in the 20th century was achieved, first of all, by using bioactive natural products, their secondary metabolites or their derivates. These substances have prolonged our life span, reduced the pain and suffering and, at the same time, revolutionized medical science. HISTORY OF ANTIBIOTICS: Antibiotics are among the most important classes of bioactive products and as much as 78% of antimicrobial drugs are extracted from nature. This paper follows the history of progress of antimicrobial drugs, which runs parallel to the history of a man's struggle against the diseases.The golden age of progress of antimicrobial drugs went on between the 1940s and 1970s. Thereafter, there is a gradual decrease in the number of newly discovered antimicrobial drugs. During the time period between 2003 and 2007 only four antibiotics were registered. CONCLUSION: The current situation in the field of antimicrobial therapy should send off a global alarm .for the creation of a well coordinated, sound and all-encompassing monitoring of the resistance, consumption of antimicrobials and investment in the new trials.

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The research on the use of pharmaco-therapeutic/pharmacoeconomic guidelines in therapy of bacterial infections was carried out in all patients hospitalized at the Clinic for Infectious Diseases of the Clinical Center of Vojvodina in a three-month period. The overall antibiotic utilization in therapy of bacterial infections was determined. The total cost of all administered antibiotics was calculated as well as the defined daily dose/100 patient-days. The structure of bacterial causes and their resistance to standard antimicrobial therapy was established for all isolated strains. The results of bacterial resistance surveillance were the basis to lay down the guidelines for initial adequate antimicrobial therapy (according to the site of infection and pathogen), in view of resistance maps for bacterial strains isolated from the tested materials. The guidelines for choosing appropriate antibiotic therapy were based on pharmaco-therapeutic/pharmacoeconomic principles, taking into account the state of bacterial resistance, drug administration schedule, and lowest therapy cost. During the implementation of guidelines for appropriate initial antimicrobial therapy, large therapy cost savings of 1.275.576.9 dinars (33.9%.) were recorded, compared to the period before the implementation of the guidelines.

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The retrospective study (2002-2007) for human leptospirosis in Vojvodina was undertaken in order to describe the distribution of the disease in relation with some environmental factors. Regarding the presented results, the major detected number of leptospirosis cases concurs with stagnant waters, wetlands, fish pond areas and protected regions, which comprised the basis for mapping of the region in three risk zones: very high risk (incidence rate higher than 5.0), high risk (2.5-5.0) and medium risk of leptospirosis infection (1.0-2.5). During the investigated period, 97 cases were registered with an average of 13.85 cases per year: 2002, 32 cases; 2003, 7; 2004, 22; 2005, 16; 2006, 4 and 2007, 16. Out of these 97 cases only 5 were women. Serovars from 11 presumptive serogroups caused infection, with a predominance of Icterohaemorrhagiae and Bratislava, accounting for 72.72% of cases together. Icterohaemorrhagiae was the commonest infecting serogroup mostly connected with fish ponds. Case fatality ratio was 9.4%.

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INTRODUCTION: Bacteria from genus Enterococcus may cause infections mostly in those who are immunocompromised and those who underwent endoscopic or surgical procedures. Endocarditis is caused by enterococci in 5-10% of cases. Its clinical presentation does not differ from endocarditis of other bacterial origin. Previous susceptibility testing is needed for appropriate choice of antibiotics against enterococci. The treatment recommendations for enterococcal endocarditis were given by American Heart Association recently. CASE REPORT: A case ofenterococcal endocarditis in a young female person hospitalised at Clinic for infectious diseases was reviewed. The disease was diagnosed during an extensive diagnostic procedure. Multiply repeated echocardiographic examination helped to find out bacterial vegetations on the mitral valve. Enterococcus species was isolated from several blood cultures. Despite powerful antibiotic treatment, the additional valvular replacement had to be done. DISCUSSION: A case of enerococcal endocarditis in a young female person was reviewed. The right diagnosis was based on a thorough clinical examination in cooperation with cardiologists using repeated transthoracic and transesophageal echocardiography. Echocardiography, even if it is transesophageal, has limited sensitivity and specificity, so it is sometimes necessary to be repeated for several times in diagnosing endocarditis. The source of endocarditis was not identified. The combined antimicrobial and surgical treatment led to the complete recovery of patient. CONCLUSION: Enterococcal endocarditis rarely occurrs in young females. Infective disease specialists sometimes face enterococcal endocarditis in their practice, mostly when they have to cope with fever of unknown origin. An appropriate approach to such conditions includes careful search for heart valve changes by repeated echocardiographic finding, if necessary.

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INTRODUCTION: Group A streptococci is the causative agent in 80 percents of human streptococcal infections. The only member of this group is Streptococcus pyogenes. CLINICALFEATURES OF GAS INFECTIONS: The various clinical entities and related complications caused by pyogenic streptococci are reviewed in the article. Pharyngitis, scarlet fever, skin and soft tissue infections (pyoderma, cellulitis, perianal dermatitis, necrotising fasciitis) and streptococcal toxic shock syndrome are described. DIAGNOSIS OF GAS INFECTIONS: The way of setting the diagnosis including epidemiological data, clinical features and the course of illness, laboratory findings and supportive diagnostic methods are represented in the article. DIFFERENTIAL DIAGNOSIS: The most important clinical entities which should be discussed in differential diagnosis of diseases caused by pyogenic streptococci are listed. TREATMENT OF GAS INFECTIONS: The major principles of etiologic treatment through widely accepted strategies related to first choice antibiotics and alternatives are reviewed.

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Development of bacterial resistance to antibiotics brought many problems among which the most important are infections caused by multiple resistant bacterial strains. Bacteria have amazing 'equipment' of biochemical and genetic mechanisms to ensure evolution and spread of antibacterial resistance genes. The results obtained from very important projects all around the world and in our country show that bacterial resistance to certain groups of antibiotics is very high (up to 100%), because of uncritical use of antibiotics out of these groups. Due to the development of resistant bacterial strains, we may soon run out of efficient antibiotics for some patients. Outcome of the race between science and pharmaceutical industry on one side, and bacterial adaptation trough acquisition of resistant genes on the other side, is very uncertain. Actions must be taken to slow down the evolution and spread of antibiotic resistance genes in which the major single factor is the proper use of antibiotics in human medicine, veterinary medicine and agriculture, respectively.

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Man's desire to conquer diseases and to find a cure for them exists from the beginnings of humankind However the first scientific discoveries of substances with antibacterial effects originate from 1877 and they are attributed to the researches of Louis Pasteur Ever since, we have been living in so-called antimicrobial era. The battle between microorganisms, trying to survive antimicrobials, and man's wish to conquer diseases, resulted in the development of resistance to antimicrobials, but simultaneously led to the development of novel antimicrobials. Their role is primarily in therapy of complicated and polymicrobial infections caused by multiresistant strains. In spite of precisely defined legal obligations, the usage of antimicrobials in Serbia is still very problematic due to their availability in pharmacies without prescription, and lack of local strategies for antimicrobial resistance surveillance.

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INTRODUCTION: The investigation was performed in three phases and included all patients hospitalized at eight selected clinics known to be the biggest antibiotic spenders in the Clinical center of Vojvodina. MATERIAL AND METHODS: The first phase comprised retrospective evaluation of the total antibiotic use in therapy of all bacterial infections during a three-month period in 2006/2007. A total cost of all spent antibiotics was calculated, and a daily dose per 100 clinical day care was defined for each of investigated clinics. In the second phase, the structure of bacterial causes and their resistance to standard antimicrobial therapy was established for all isolated strains from each clinic. According to the the results of bacterial resistance surveilance, guidelines for initial adequate antimicrobial therapy were made (regarding localization and type of bacteria) considering resistance maps for isolated bacterial strains. The guidelines took into consideration all essential ellements: pharamcotherapeutic/pharmacoeconomic principles, bacterial resistance, patterns of antimicrobial prescriptions and lowest therapy costs. RESULTS AND CONCLUSION: In the third phase, (three-month period in 2007/2008), the guidelines were implemented in therapy of bacterial infections. In this period, only by implementing the guidelines for initial adequate antimicrobial therapy, the therapy costs savings were 2027018.52 dinars (12.8%) at four of eight investigated clinics, compared to the period before implementation of the guidelines. This was the first pharmacoeconomic study in Vojvodina.

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The investigation was performed in three phases and included all patients hospitalized at the Clinic for Infectious Diseases of the Clinical Center of Vojvodina. The first phase comprised retrospective evaluation of the total antibiotic use in therapy of all bacterial infections during a three-month period in 2006/2007. A total cost of all spent antibiotics was calculated, and a daily dose per 100 clinical day care was defined In the second phase, the structure of bacterial causes and their resistance to standard antimicrobial therapy was established for all isolated strains at the Clinic for infectious diseases. According to the the results of bacterial resistance surveilance, guidelines for initial adequate antimicrobial therapy were made (regarding localization and type of bacteria) considering resistance maps for isolated bacterial strains. The guidelines took into consideration all essential elements: pharamcotherapeutic/pharmacoeconomic principles, bacterial resistance, patterns of antimicrobial prescriptions and lowest therapy costs. In the third phase, (three-month period in 2007/2008), the guidelines were implemented in therapy of bacterial infections. In this period, only by implementing the guidelines for initial adequate antimicrobial therapy, the therapy costs savings were 1275576.9 dinars (33.9%) at the Clinic for Infectious Diseses, compared to the period before implementation of the guidelines. Pharmacoeconomic investigations should become standard part of the health system in our country.

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INTRODUCTION: Antimicrobial resistance become emerging global problem. Particularly dramatic increase in the number and type of bacteria resistant to numerous and structurally different antibiotics has taken place in the last two decades. MATERIALS AND METHODS: A total of 558 strains of different bacteria isolated from blood cultures during 2007 were tested to susceptibility to different antibiotics by disc diffusion method according to CLSI. All strains were isolated and identified in the laboratories of Microbiology Center at the Institute for Public Health in Novi Sad. A total of 7748 blood cultures were processed and microorganisms were isolated from 558 of them. Blood samples were taken from the patients hospitalized in the Institutes and Clinics of Novi Sad Clinical Center and Institute for Health Care of Children and Adolescents in Novi Sad RESULTS: The structure ofpathogens shows that the most frequent isolates are Gram-positive bacteria, above all coagulase- negative staphylococci with 285 isolates (51,1%) followed with Enterococcus spp (41 isolates - 6,8%). Percentage of resistance to Methicillin in staphylococci strains was 66,7%; all isolates was susceptible to Vancomycine. Enterococcus spp showed 13,2% resistance to Vancomycine. Among Gram-negative pathogens, we find that the most frequent is Klebsiella spp with 40 isolates (7,2%) and have high resistance to wide spectrum Cephalosporins - 82,5%. Acinetobacter spp participate with 41 isolates (7,3%) and 43,9% isolates are resistant to Imipenem Also, Pseudomonas aeruginosa (20 isolates) shows high resistance to Imipenem (40%) but lower resistance to wide spectrum Cephalosporines (27,8%). CONCLUSION: Having compared the resistance to antibiotics in 2002 and 2007 speak for the trend of growing antimicrobial resistance to the very antibiotics which are recommended as the empiric or initial therapy-wide spectrum Cephalosporins, Fluoroquinolons and Imipenem.

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INTRODUCTION: Staphylococcus aureus is a major cause of both hospital- and community-acquired infections worldwide. Since the introduction of methicillin into clinical use, methicillin-resistant S. aureus strains have emerged with increasing frequency throughout the world. The aim of the study was to determine frequency of resistance to methicillin and other most commonly used antibiotics of S aureus strains isolated from hospitalized patients. MATERIAL AND METHODS: During the period 1.1.-31. 12. 2007, 226 strains of S. aureus isolated from hospitalized patients were tested for their susceptibility to penicillin, methicillin, erythromycin, clindamycin, gentamycin, sulfamethoxazolle-trimethoprim, fusidic acid and vancomycin using disc diffusion technique. RESULTS: Resistance to methicillin was detected in 20 (7.5%) S. aureus strains. All of them were susceptible to vancomycin. The resistance to other antimicrobial agents varied from 5% for sulfamethoxazolle-trimethoprim to 75% to gentamycin. Among methicillin susceptible strains, high resistance (84.1%) was found to penicillin only The resistance to other antimicrobial agents was low, ranging from 0 for fusidic acid and vancomycin to 12.2% for gentamycin. CONCLUSION: Our results show low rate of methicillin-resistant S. aureus strains compared to other authors "findings, but also the presence of multidrug-resistant isolates and isolates susceptible to vancomycin only These facts suggest the need for further monitoring of susceptibility in order to take adequate measures to prevent and control spreading of resistant strains.

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Several studies have reported high rate of antimicrobial resistance, particularly in strains isolated from hospitals. The aim of this study was to review the pathogens associated with nosocomial infections at the Clinic for abdominal surgery, Clinic for urology, Clinic for orthopedic surgery and Clinic for resuscitation and anaesthesia of the Clinical Center of Vojvodina. The analysis of the collected data gave indecisive results. The percentage of positive cultures was too low to enable making therapeutic recommendations. The first-line antibiotics, according to the international reccomendations, should be included more often in sensitivity tests of isolated bacterial strains. Isolated bacteria were most frequently tested to the second and third-line antibiotics respectively, to which the resistance rate is becoming concerningly high.

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INTRODUCTION: Infectious diseases are a part of the history of this region. Devastating epidemics of plague, smallpox, and cholera were frequent during the 18th and the 19th centuries. Other infectious diseases were a serious problem as well: alimentary tract infections, scarlet fever, diphtheria, whooping cough. Geographic position, climate, migrations, as well as the tradition and lack of medical staff and medications, affected the frequency and outcome of infections. THE HISTORY OF THE TREATMENT OF INFECTIOUS DISEASES: Patients with infectious diseases were first treated at home. Later, a hospital in Visarion street was opened as an isolation facility and a hospital for homeless patients. The development of science and the education of medical personnel exerted the greatest influence on the control and later treatment of infectious diseases. These measures resulted in the establishment of the first specialized medical institutions in Novi Sad during the cholera outbreak in 1884. After that, temporary pediatric units were organized for the treatment of scarlet fever, diphtheria and smallpox. A ward for infectious diseases was founded in the The Great City Hospital in the second half of the 19th century (1892). The 20th century was a period of control and eradication of infectious diseases in Vojvodina (smallpox, malaria, diphtheria, polio). MODERN INFECTIOUS DISEASES: Nowdays, major infectious deseases include respiratory, alimentary and parasitic infections. However, new diseases are being registered as well - hemorrhagic fevers, Lyme disease, HIV infection. The Infectologic Service in Novi Sad was developed from an Infectology Departement as part of the Departement of Internal Diseases in the new Provincial Hospital (1909) to the independent Departement for Infectious Diseases (1945). Today, Clinic of lnfectious Diseases is an integral part of the Clinical Center of Vojvodina. DEPARTMENT OF INFECTIOUS DISEASES: The Department of Infectious Diseases of the Faculty of Medicine in Novi Sad was founded in 1960. Undergraduate studies started in 1963/64 for students of medicine and in 1978/79 jor dentistry students. Today. the faculty of the Department takes part in undergraduate studies of medicine, dentistry, health care, as well as in graduate programs. The faculty members are also taking part in specialization programs at the Faculty of Medicine. Infectious disease physicians are involved in the activities of the Infectology Section (founded in 1979) of the Society of Physicians of Vojvodine of the Medical Society of Serbia. The first president of the Infectology Section was Dr. Vera Mudric, professor, infectologists, whereas Dr. Grozdana Canak, professor, was the vice-president from 2000-2004. The Infectology Section collaborates with various national and international societies for infectious diseases.

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