Faculty of Medicine

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The influence of illness duration before diagnosis on clinical characteristics and outcome in human brucellosis
(SAGE Publications, 2019-05-06)
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Siskova, Dijana
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Vidinic, Ivan
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Our study assesses the influence of illness duration before establishing the diagnosis of brucellosis and initiating therapy on patients’ main clinical characteristics and outcome in an endemic area. The medical files of 297 patients with brucellosis were retrospectively analysed. They were divided into four groups according to illness duration before initiating therapy: <10 days; 11–30 days; 31–90 days; and >90 days. There were significant differences in the occurrences of fever (P = 0.019), focal forms (P = 0.026), spondylitis (P = 0.034) and therapeutic failures (P = 0.006) between the groups. Duration of >30 days before treatment initiation is responsible for more serious clinical presentation and outcome, whereas illness duration of >90 days further worsens the clinical progression in human brucellosis.
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FEVER OF UNKNOWN ORIGIN: CLINICAL CHARACTERISTICS AND ETIOLOGICAL SPECTRUM
(Здружение на инфектолози на Република Македонија = Macedonian Society of Infectious Diseases, 2024-10-06)
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Shopova, Zhaklina
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Vidinic, Ivan
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Objective: This study aimed to provide an overview of the etiological distribution, clinical features, and laboratory findings among patients with classic fever of unknown origin (FUO) admitted to the University Clinic for Infectious Diseases and Febrile Conditions in Skopje. Materials and Methods: All participants underwent a comprehensive medical history review, physical examination, and predetermined laboratory investigations. The final diagnosis was established using specific diagnostic procedures guided by potential diagnostic clues (PDCs). After diagnosis, patients were categorized into infectious and non-infectious FUO groups. Results: The analysis included 47 participants, with a mean age of 57 years, the majority of whom were male. Fever lasted an average of 30 days, with a median temperature of 39 °C. Infections accounted for 53.2% of cases, followed by inflammatory non-infectious diseases (25.5%), malignancies, and other miscellaneous conditions (10.6%). The most frequent symptoms were myalgia, arthralgia, fever, sweating, and malaise. On physical examination, hepatosplenomegaly, heart murmurs, joint swelling, and skin rashes were the predominant findings. Significant laboratory abnormalities included elevated ferritin and procalcitonin levels across groups. Conclusion: Specific variations in clinical presentation and laboratory findings may help facilitate a more rapid differential diagnosis of classic FUO.
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RECURRENT CLOSTRIDIOIDES DIFFICILE COLITIS – CASE REPORT
(Peytchinski Publishing Ltd., 2024-10-06)
Georgievska, Dajana
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Vidinic, Ivan
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Shopova, Zhaklina
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Rangelov, Goran
Recurrent Clostridium difficile infection (rCDI) is usually defined as the reappearance of enteral symptoms 2-8 weeks after resolution of the initial episode with an appropriate therapy. Recurrence occurs in approximately 25% of patients within the first 30 days of the treatment. A 62-year-old female was initially hospitalized at our hospital within the intensive care unit (ICU) due to acute encephalitis and bilateral bronchopneumonia. Her comorbidities were diabetes mellitus and hypertension. She was treated with a combination of parenteral beta-lactam antibiotics for 35 days, acyclovir, probiotics, gastric suppression, and other supportive therapies. On the 18th hospital day, she developed diarrhea with liquid mucous green stools, prompting stool cultures and a C.difficile toxins test, which were negative and her condition stabilized spontaneously. A week later, she experienced a recurrence of enteral symptoms when stool cultures showed C.difficile positivity, but negative toxin tests. A colonoscopy was performed, revealing pseudomembranous pancolitis. Treatment continued with intravenous metronidazole and oral vancomycin for two weeks, alongside probiotics. This led to gradual improvement and normalization of stool consistency. Control cultures were C.difficile negative, and she was discharged after 49 days. Three weeks later, she complained of persistent watery stools and malaise, thus she was readmitted. New stool cultures confirmed C.difficile positivity with negative toxin tests. A repeat colonoscopy showed significant regression of pseudomembranous colitis and biopsy results indicated chronic nonspecific colitis. She was treated with probiotics, intravenous metronidazole for a week, and oral vancomycin. On first follow-up visit after three weeks, she returned asymptomatic with normal stools, and was advised to continue oral vancomycin, rifaximin, and probiotics. A second follow-up visit two weeks later confirmed normal stool characteristics. Prolonged use of antibiotics, extended hospital stays, advanced age, severe preexisting illness are significant risk factors for recurrent CDI. Prolonged oral vancomycin therapy has shown high efficacy in treatment of this serious condition.
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Epidemiological and clinical features of patients with Clostridoides difficile infection
(Elsevier BV, 2024-12)
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Eftimovski, Georgi
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Vidinic, Ivan
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Georgievska, Dajana
AIM Investigation and identification of epidemiological characteristics, risk factors and treatment regimens effectivity in reducing morbidity and mortality. BACKGROUND C.difficile remains the leading cause of health care associated diarrhea, usually as a result of irrational use of antimicrobial therapy. METHODS Retrospective descriptive study (October 2020-january2024) included all patients with clinical symptoms of Clostridoides difficile infection (CDI) admitted at our clinic. Diagnosis is based on isolation with coproculture for C.difficile, toxin confirmation with immunochromatography, small number confirmed with PCR film array. RESULTS 594 inpatients with clinical symptoms of CDI were evaluated and diagnosis was confirmed in 44. Average mean age was 58,5 (29-90)years, approximately with no differencies on sex representation. Comorbidities and previous hospitalisations were noted in two third of them, and 63% had used antimicrobial drugs, while 34% had history of corticosteroid usage and 4,5% imunosupressive therapy. Often used antibiotics cephalosporins, clindamycine, quinolones and macrolides. 68,2% had history of protein pump inhibitors usage. Culture positive were 38%, toxinA/B is confirmed with immunochromatography in 77% of patients, PCR film array confirmed C.difficile toxin A/B in the remaining patients. Treatment is carried out with oral vancomycine in 56% of patients, 15% with metronidazole and the remaining with combination of two drugs. Regarding outcomes 90% of patients were cured while 10% had fatal outcomes and CDI is not considered the main cause of death. CONCLUSION Elderly patients with antibiotic history treatment, previous healthcare exposures and comorbidities were the most affected by CDI infection. Metronidazole and vancomycine has shown good therapeutic results.
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ARTERIAL THROMBOSIS IN A COVID-19 PATIENT
(Македонско лекарско друштво = Macedonian medical association/De Gruyter, 2022)
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Shopova, Zhaklina
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Vidinic, Ivan
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Arterial thrombosis is one of the complications descry bed in severe COVID-19. Our presented case had throm bosis of abdominal aorta and left renal artery despite prophylactic treatment with low molecular heparin - enoxaparine. Thrombotic lesions were defined with CT angiography. Treatment consisted of therapeutic doses of low molecular heparin and Bergman solution. After 42 day of hospital treatment, the patient was dischar ged and vascular surgeon consultations were performed. By presenting this case, we want to draw attention to the need for early diagnosis of this complication and to highlight the need for treatment with therapeutic doses of low molecular heparin in patients with severe Covid pneumonia or oxygen dependent patients and in risk for thrombosis.
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Clinical outcome in hospitalized patients with COVID-19 and Diabetes
(Macedonian Infectious Diseases Society, 2022-11-11)
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Shopova, Zhaklina
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Vidinic, Ivan
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Epidemiological and clinical characteristics of imported falciparum malaria in the Republic of North Macedonia : A 13-year experience
(Springer Science and Business Media LLC, 2023-04-03)
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Khezzani, Bachir
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Semenakova-Cvetkovska, Vesna
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Vidinic, Ivan
Plasmodium falciparum is the leading cause of imported malaria and the most common cause of death in returning travellers. Aim To identify the main epidemiological and clinical characteristics of patients with imported falciparum malaria in the Republic of North Macedonia. Material and methods Retrospectively analyzed were the epidemiological and clinical features of 34 patients with imported falciparum malaria who were diagnosed and treated at the university clinic for infectious diseases and febrile conditions in Skopje from 2010 to 2022. Malaria diagnosis was based on the microscopic detection of parasites in thick and thin blood smears. Results All patients were male, with a median age of 36 years and a range of 22–60 years. Of the patients 33 (97.1%) acquired the disease in Sub-Saharan Africa. All patients except one stayed in endemic regions for work/business purposes. Chemoprophylaxis was completely applied in 4 (11.8%) patients. The median time of onset between the symptoms and diagnosis was 4 days, with a range of 1–12 days. Prevailing clinical manifestations were fever, chills, and splenomegaly in 100%, 94%, and 68% of patients, respectively. Severe malaria was noticed in 8 (23.5%) patients. In 5 (14.7%) patients the initial parasitemia was higher than 5%. On admission, thrombocytopenia, hyperbilirubinemia, and elevated alanine aminotransferase were registered in 94%, 58%, and 62% of patients, respectively. Out of the 33 patients with adequate follow-up, the outcome was favorable in 31 (93.9%). Conclusion In every febrile traveller returned from Africa, imported falciparum malaria should be an essential part of differential diagnostic considerations.
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Increased risk of brucellosis misdiagnosis in regions that lose their endemicity
(Malaysian Society of Parasitology and Tropical Medicine, 2023-03-31)
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Khezzani, Bachir
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Vidinic, Ivan
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Over the last decades, the epidemiology of human brucellosis globally has been subjected to significant changes, with the eradication of many existing endemic hot spots. This paper describes three cases with initial misdiagnosis of brucellosis that were managed during 2011-2017 in Republic of North Macedonia, country that until recently has been declared as endemic region. In spite of the fever, constitutional symptoms, focal disease (spondylitis, pneumonia and orchitis) and previous contact with domestic animals, brucellosis was not initially recognized, and patients were inadequately managed. Brucellosis should be part of differential diagnostic considerations in patients exposed to contacts with animals, with osteoarticular symptoms and signs, constitutional manifestations and different organ involvements in endemic regions where its incidence is diminishing.
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The role of Brucellacapt test for follow-up patients with brucellosis
(Elsevier BV, 2010-09)
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Sopova, Zaklina
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Vidinic, Ivan
The dynamic of Brucellacapt titers was evaluated in 104 patients with brucellosis with favorable outcome and in 28 patients with persistent illness duration, during the follow-up period of 15 months. In patients with favorable outcome, a permanently decreasing tendency of Brucellacapt titers was evident. Titers< or =1/320 were noted in 27% and 90% of the patients, at the end of the 4th and 15th month, respectively. In patients with persistent disease, persistence or slow titre regression during the entire follow-up period was evident. Four and 15 months of the treatment, titers of 1/320 were registered in 4%, and 14%, respectively, and in no one less than 1/320. The evaluation of Brucellacapt titres between recovered and patients with persistent illness showed significant difference at the 3rd month after beginning of treatment. The evolution of Brucellacapt titers over time proves to be a handy indicator of brucellosis activity when combined with clinical parameters.
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Human brucellosis in Macedonia - 10 years of clinical experience in endemic region
(2010-08)
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Krteva, Ljiljana
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Vidinic, Ivan
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Sopova, Zaklina
To present our 10-year clinical experience with brucellosis patients at the University Clinic for Infectious Diseases and Febrile Conditions in Skopje, Republic of Macedonia. A total of 550 patients with brucellosis treated between 1998 and 2007 were retrospectively assessed for their demographic, epidemiological, and clinical characteristics and outcomes. Of the 550 patients, 395 (72%) were male. The median age was 34.5 years (range, 1-82). Direct contact with infected animals was recorded in 333 (61%) patients and positive family history in 310 (56%). The most frequently seen symptoms were arthralgia (438, 80%), fever (419, 76%), and sweating (394, 72%). The most common signs were fever and hepatomegaly, which were verified in 357 (65%) and 273 (50%) patients, respectively. Focal brucellosis was found in 362 patients (66%) and osteoarticular in 299 (54%). Therapeutic failures were registered in 37 (6.7%) patients. Of the 453 (82%) patients who completed a follow-up period of at least 6 months, relapses occurred in 60 (13%). Due to non-specific clinical manifestation and laboratory parameters, brucellosis should be considered one of the differential diagnoses of any patient suffering from obscure involvement of various organs in a brucellosis-endemic region. High percentage of relapses and therapeutic failures in spite of the use of currently recommended therapeutic regimens indicates the seriousness of this zoonosis and the need to control it.

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