Rickettsiae and rickettsial diseases in Croatia: Implications for travel medicine.

Aim: To review the current state of knowledge concerning rickettsiae and rickettsioses in Croatia and to discuss their implications for travellers.

Methods: The PubMed database was searched from 1991 to 2015 by combining the words "rickettsia," "rickettsiosis", "travellers" and "Croatia".

Results: Since 1969, Croatia appears to be free of epidemic typhus (ET) caused by Rickettsia prowazekii and the last case of Brill-Zinsser disease was recorded in 2008.

A case of Mediterranean spotted fever associated with severe respiratory distress syndrome.

Mediterranean spotted fever (MSF) is usually a mild endemic rickettsial disease occurring in southern Croatia. We have reported the clinical and epidemiological characteristics of an acute MSF case associated with severe respiratory distress syndrome and hemodynamical instability. The patient recovered completely after antimicrobial treatment.

Association of Kaposi’s sarcoma-associated herpesvirus (KSHV) with bladder cancer in Croatian patients.

As the seventh most common human malignancy, bladder cancer represents a global health problem. In addition to well-recognized risk factors such as smoking and exposure to chemicals, various infectious agents have been implicated as cofactors in the pathogenesis of urothelial malignancies. The aim of the present study was to assess the possible association of viral infection and bladder cancer in Croatian patients.

Antimicrobial susceptibility of gram-negative and gram-positive bacteria collected from countries in Eastern Europe: results from the Tigecycline Evaluation and Surveillance Trial (T.E.S.T.) 2004-2010.

The Tigecycline Evaluation and Surveillance Trial (T.E.S.

Evidence of an autochthonous Toscana virus strain in Croatia.

Background: Phleboviruses are large and widespread group of viruses that are transmitted by arthropods and they have been reported to circulate in endemic regions of Mediterranean Basin, including Croatia.

Objectives: To investigate the role of Toscana virus, as a cause of the aseptic meningitis, in summer months in Croatia.

Study Design: Samples from 30 patients with aseptic meningitis were retrospectively tested by serology and RT-PCR for TOSV.

Antimicrobial effects of wine: separating the role of polyphenols, pH, ethanol, and other wine components.

While the antimicrobial effectiveness of wine is well documented, relative contributions of the wine components to its antimicrobial activity is controversial. To separate the role of wine phenolics, ethanol, and pH from other wine constituents, the antimicrobial effects of intact wine were compared to that of phenols-stripped wine, dealcoholized wine, ethanol, and low pH applied separately and in combination, against 2 common foodborne pathogens, Salmonella enterica serovar Enteritidis and Escherichia coli. All samples were biochemically characterized with respect to their total phenolics and resveratrol content, antioxidant capacity, ethanol content, and pH.

High prevalence and molecular characterization of extended-spectrum β-lactamase-producing Proteus mirabilis strains in southern Croatia.

The aim of this study was to determine the prevalence and antibiotic resistance rates of extended-spectrum β-lactamase (ESBL)-producing Proteus mirabilis strains isolated from inpatients at the Split University Hospital (southern Croatia) during a survey performed between 2005 and 2008. A total of 2152 consecutive isolates of P. mirabilis were isolated.

Occurrence of OXA-107 and ISAba1 in carbapenem-resistant isolates of Acinetobacter baumannii from Croatia.

Carbapenem-resistant isolates of Acinetobacter baumannii from intensive care units at Split University Hospital, Split, Croatia, were studied. Most (100 of 106) had ISAba1 inserted upstream of a bla(OXA-107) gene, encoding an unusual OXA-51-type oxacillinase. Pulsed-field gel electrophoresis revealed that the isolates formed three clusters belonging to the sequence group 2 (European clone 1) lineage.

Rickettsia hoogstraalii sp. nov., isolated from hard- and soft-bodied ticks.

A novel spotted fever group Rickettsia was found in Haemaphysalis sulcata ticks collected from sheep and goats in Croatia in 2006. At the same time, a genetically identical organism was co-isolated with the embryonic cell line CCE3 obtained from the soft tick Carios capensis in Georgia, USA. In this study, further phenotypic and genotypic characteristics of the novel rickettsial strain present in H.

Rickettsia helvetica in Dermacentor reticulatus ticks.

We report on the molecular evidence that Dermacentor reticulatus ticks in Croatia are infected with Rickettsia helvetica (10%) or Rickettsia slovaca (2%) or co-infected with both species (1%). These findings expand the knowledge of the geographic distribution of R. helvetica and D.

Molecular detection of Theileria sp. in ticks and naturally infected sheep.

Seven healthy sheep and 10 sheep diagnosed with piroplasmosis based on clinical signs were tested for the presence of babesiae and theileriae. Using the molecular techniques, two species of theileriae were detected and characterized. Theileria ovis was present mostly in healthy sheep and in Rhipicephalus ticks collected from infected sheep.

War-associated cases of typhoid fever imported to Split-Dalmatia County (Croatia).

Objective: The goal was to investigate the number and origin of typhoid fever cases in Split-Dalmatia County, Croatia, during the period of 1970-2005.

Methods: Data from the medical records of typhoid fever cases treated at the University Hospital during the 35-year period were analyzed. Cases were defined as those in which Salmonella typhi was isolated from blood and/or stool.

Molecular identification of Rickettsia felis-like bacteria in Haemaphysalis sulcata ticks collected from domestic animals in southern Croatia.

Haemaphysalis sulcata ticks collected from sheep and goats in southern Croatia were found infected with rickettsiae. Molecular analysis of the complete gltA gene and portion of 17 kDa and ompB genes revealed the presence of Rickettsia felis-like bacteria in up to 26% of tested ticks.

High prevalence of antibodies to lymphocytic choriomeningitis virus in a murine typhus endemic region in Croatia.

A retrospective serological survey was carried out by the indirect immunofluorescence assay (IFA) and complement fixation (CF) test in a sample of 425 healthy residents (240 females and 185 males) to investigate whether Lymphocytic choriomeningitis virus (LCMV) circulates in the rural area of the northern Croatian island of Vir, which is known to be endemic for murine typhus. The overall prevalence of LCMV antibodies detected by IFA was found to be 36% (155 out of 425) and 13% (54 out of 425) by CF. No significant difference in the LCMV seroprevalence was observed with respect to age and gender by any of the methods used.

Clinical and epidemiological features of hospitalized acute Q fever cases from Split-Dalmatia County (Croatia), 1985-2002.

Background: Q fever shows a wide diversity of clinical manifestation. Q fever is endemic in northern Croatia, but the epidemiological and clinical characteristics of this disease in various ecological areas of southern Croatia are unclear.

Material/methods: From January 1985 to December 2002, acute Q fever cases hospitalized at Split University Hospital were analyzed.

Prevalence and antimicrobial resistance of extended-spectrum beta-lactamases-producing Escherichia coli and Klebsiella pneumoniae strains isolated in a university hospital in Split, Croatia.

The prevalence of Escherichia coli and Klebsiella pneumoniae that produce extended-spectrum b-lactamases (ESBL) was investigated in patients of a university hospital in Split, Croatia. Patients were grouped according to age (pediatric vs. adult), antibiotic type, and hospital ward.

Q fever epidemic among employees in a factory in the suburb of Zadar, Croatia.

Aim: To examine the role of wind in the spread of Q fever (Coxiella burnetii) from the source of infection (sheep on the pastures) to the factory where there was an outbreak of Q fever among the employees.

Methods: We performed clinical (fever, coughing, myalgias, arthralgias), laboratory (complete blood test, aminotransferases, antibodies to Coxiella burnetii), radiographic (chest X-ray), and epidemiological (questionnaire) analysis on 47 of 110 employees of the plant in a suburb of Zadar. Sera of 182 sheep were tested for antibody to C.

Detection and identification of spotted fever group rickettsiae in ticks collected in southern Croatia.

A total of 197 ticks belonging to four species (Haemaphysalis punctata, Hyalomma marginatum, Rhipicephalus bursa and Dermacentor marginatus) collected in October 2000 from domestic animals in southern Croatia were examined for the presence of rickettsiae by molecular techniques. Specific sequences of the rickettsiae were detected in 25 (12.7%) of ticks tested.

Prevalence of antibodies to spotted fever group rickettsiae in the region of Split (southern Croatia).

The prevalence of IgG antibodies to spotted fever group rickettsiae (SFG) was investigated by the indirect immunofluorescence assay in a sample of 1207 healthy residents of the central part of southern Croatia (eastern coast of Adriatic Sea). Sera obtained from subjects living in three different places of residency (urban, suburban and rural environs of the region) were tested. Overall 528 (43.