Mile Bosilkovski, Marija Dimzova, Marija Cvetkova, Kostadin Poposki, Katerina Spasovska and Ivan Vidinic
Introduction. The study aimed to compare the etiologic spectrum of diseases causing fever of unknown origin (FUO) and methods for definitive diagnosis in a tertiary care hospital in the Republic of North Macedonia during two different time periods.
Patients and methods. There were analysed retrospectively the causes for FUO and final diagnostic approaches in 185 patients with classic FUO that were treated at the University Hospital for Infectious Diseases in Skopje during two time periods. Seventy nine patients were treated during 1991 to 1995 and 106 patients during 2011 to 2015.
Results. When comparing these two periods, infections were present in 46.8% and 29.2% (p = 0.014), non-infective inflammatory disorders in 22.8% and 25.5% (p = 0.674), neoplasms in 10.1% and 13.2% (p = 0.522), miscellaneous in 8.9% and 12.3% (p = 0.461) and undiagnosed cases in 11.4% and 19.8% (p = 0.124), respectively. The most common causes for FUO during the first period were abscesses (8.9%), tuberculosis and systemic lupus erythematosus (7.6% each), whereas in the second period the commonest causes were adult onset Still disease and solid organ neoplasm (7.6% each), polymyalgia rheumatica, abscesses and visceral leishmaniasis (5.7% each). The newer imaging techniques and clinical course evaluation had superior diagnostic significance during the second period.
Conclusion. A changing pattern of diseases causing FUO during the examined periods was evident. Infections continue to be the most common cause but with decreasing incidence when compared to 20 years ago. Even nowadays clinical evaluation and follow-up still remain the vital diagnostic tools in determining the etiology of FUO.
Krsto Grozdanovski, Zvonko Milenkovikj, Ilir Demiri, Katerina Spasovska, Marija Cvetanovska, Velimir Saveski and Biljana Grozdanovska
Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to an infection and it is a major cause of morbidity and mortality worldwide. The aim of this study is to describe epidemiology of community-acquired sepsis in the Intensive care unit (ICU) of the Macedonian tertiary care University Clinic for Infectious Diseases. A prospective observational study was conducted over a 6-year period from January, 2011 to December, 2016. All consecutive adults with community-acquired sepsis or septic shock were included in the study. Variables measured were incidence of sepsis, age, gender, comorbidities, season, source of infection, complications, interventions, severity indexes, length of stay, laboratory findings, blood cultures, 28-day and in hospital mortality. Of 1348 admissions, 277 (20.5%) had sepsis and septic shock. The most common chronic condition was heart failure (26.4%), and the most frequent site of infection was the respiratory tract (57.4%). Median Simplified Acute Physiology Score (SAPS II) was 50.0, and median Sequential Organ Failure Assessment (SOFA) score was 8.0. Blood cultures were positive in 22% of the cases. Gram-positive bacteria were isolated in 13% and Gram-negatives in 9.7% of patients with sepsis. The overall 28-day and in hospital mortality was 50.5% and 56.3% respectively. The presence of chronic heart failure, occurrence of ARDS, septic shock and the winter period may influence an unfavorable outcome. Mortality compared to previous years is unchanged but patients that we have been treating these last 6 years have had more severe illnesses. Better adherence to the Surviving Sepsis guidelines will reduce mortality in this group of severely ill patients.
Krsto Grozdanovski, Zvonko Milenkovikj, Ilir Demiri, Katerina Spasovska, Marija Cvetanovska, Goran Rangelov, Velimir Saveski and Biljana Grozdanovska
The aim of this study was to evaluate the usability of systemic inflammatory response syndrome (SIRS) and commonly used biochemical parameters as predictors for positive blood culture in patients with sepsis. The study included 313 patients aged ≥18 years with severe sepsis and septic shock consecutively admitted in the Intensive Care Unit (ICU) of the University Clinic for Infectious Diseases in Skopje, Republic of North Macedonia. The study took place from January 1, 2011 to December 31, 2017. We recorded demographic variables, common laboratory tests, SIRS parameters, site of infection, comorbidities and Sequential Organ Failure Assessment (SOFA) score. Blood cultures were positive in 65 (20.8%) patients with sepsis. Gram-positive bacteria were isolated from 35 (53.8%) patients. From the evaluated variables in this study, only the presence of four SIRS parameters was associated with bacteremia, finding that will help to predict bacteremia and initiate early appropriate therapy in septic patients.
Aleksandar Petlichkovski, Zvonko Milenkovic, Eli Djulejic, Bisera Jefremovska, Haris Babacic, Ljubomir Ivanovski, Irena Kondova Topuzovska, Katerina Spasovska and Mirko Spiroski
Background: Infection by the pandemic influenza A (H1N1)pdm09 virus results in significant pathology disease in many cases in different populations worldwide. The natural killer (NK) cells are among the major effectors important in early innate immune responses to viral infections, interacting with host cells through their activating or inhibiting receptors.
Aim: The aim of this study was to analyze Killer Ig-Like Receptor (KIR) gene polymorphisms in critically ill Macedonian patients with pandemic influenza A (H1N1)pdm09 infection.
Material and Methods: The studied sample consists of 63 critically ill Macedonian patients with pandemic influenza A (H1N1)pdm09 infection. The population genetics analysis package, Arlequin, was used for analysis of the data.
Results: We found that all 16 KIR genes were observed in the studied individuals and framework genes (KIR3DL3, KIR3DP1, KIR2DL4, and KIR3DL2) were present in all individuals. The results of tested linkage disequilibrium (LD) among KIR genes demonstrated that KIR genes present a wide range of linkage disequilibrium. Comparison of KIR gene frequencies between critically ill H1N1/09 Macedonian patients and healthy subjects reveals statistically significant difference for frequency of KIR2DL1 (F=1 in the patients group, and 0.94 in the control group, p=0.045).
Conclusion: We did not found any significant association of all 16 KIR genes or KIR genotypes with critically ill (H1N1)pdm09 Macedonian patients, except for the KIR2DL1.