Pediatric allergist and clinical immunologist. Interested in asthma, food allergy, drug allergy, immunotherapy, immunization and primary immunodeficiencies.
Acta medica Croatica : casopis Hravatske akademije medicinskih znanosti, 2011
Allergic rhinitis is the most prevalent form of chronic rhinitis in children. It is driven by all... more Allergic rhinitis is the most prevalent form of chronic rhinitis in children. It is driven by allergic inflammation and is commonly associated with other atopic diseases such as asthma and atopic eczema. The main allergens are primarily aeroallergens: house dust mite, and tree, grass and weed pollen. It is, however, not exceptional to experience symptoms of allergic rhinoconjunctivitis in conjunction with food allergy and oral food allergy syndrome, especially in infants and toddlers. Allergic rhinitis is often associated with allergic asthma, either preceding it, or developing later and making it more difficult to treat. The mainstay of treatment is exposure prophylaxis, antihistamines, leukotriene antagonists and intranasal corticosteroids. Allergic rhinitis is one of the prime indications for specific allergen immunotherapy, which may have a preventive effect on the development of asthma. Allergic rhinitis associated with intermittent or mild persistent asthma may be a good indic...
Results of determination of circulating histamine releasing autoantibodies using histamine releas... more Results of determination of circulating histamine releasing autoantibodies using histamine release urticaria test in 12 children (aged 3 to 18 years, mean age 8.5 years; 7 female and 5 male) with chronic urticaria are presented. Standard work-up including detailed history, allergy testing and routine laboratory findings did not disclose any plausible cause of chronic/recurrent urticarial eruption in these children. All children underwent serum-induced basophil histamine release urticaria test. At serum dilution of 12.5%, the mean percent of histamine liberation was 40.8% (range 18%-77%; normal <16.5%), which indicated the presence of autoantibodies to Fc epsilon RI and/or to the IgE-Fc epsilon RI complex. The percent of histamine release did not correlate with patient age or duration and severity of symptoms. Thus the autoimmune basis of chronic urticaria was established. Associated antithyroid autoantibodies were found in two patients. Complete or partial remission was obtained ...
SUMmARY An 8 year old girl with primary pulmonary hypertension and signs of heart failure was giv... more SUMmARY An 8 year old girl with primary pulmonary hypertension and signs of heart failure was given 17*5 mg of verapamil injected into the pulmonary artery over 25 minutes to test for the reversibility of pulmonary arteriolar obstruction. Pulmonary artery pressure fell from 70/50 to 35/25 mm Hg. Treatment with 40 mg verapamil by mouth four times daily was started, and she was discharged. She gradually became asymptomatic and resumed the activities of a normal child of school age. On recatheterisation seven months later her pulmonary artery pressure was 30/ 10 mm Hg. She was still doing well 12 months after the start of treatment. Primary pulmonary hypertension has a poor prog-nosis and is a frustrating problem for the managing physician. Calcium antagonists have smooth muscle relaxing properties ' and well known systemic vaso-dilator and antihypertensive effects.2 McMurtry et al showed on a rat lung model that calcium antagonists were capable of inhibiting the hypoxic pulmonary...
U radu prikazane su smjernice za lijecenje anafilaksije i anafilaktickog soka u djece koje je don... more U radu prikazane su smjernice za lijecenje anafilaksije i anafilaktickog soka u djece koje je donijela radna skupina Hrvatskog drustva za alergologiju i klinicku imunologiju.
Temporal association of an adverse event to immunization should not automatically be considered t... more Temporal association of an adverse event to immunization should not automatically be considered to constitute a causal relation If the events are not causally related, the continuation of immunization is advised Atopy and autoimmunity are not associated with history of immunization Comorbid disorders like multiple sclerosis, Guillain-Barre syndrome and thrombocytopenia may constitute relative or absolute contraindications to specific vaccines
Analiza izdahnutoga kondenziranog zraka zadnjih se godina opisuje kao moguca nova metoda u dijagn... more Analiza izdahnutoga kondenziranog zraka zadnjih se godina opisuje kao moguca nova metoda u dijagnostici i longitudinalnom pracenju plucnih bolesti. Uzorak izdahnutoga kondenzata dobije se vrlo jednostavno: izdisanjem zraka u rashlađeni spremnik. Metoda dobivanja uzorka je neinvazivna, lako se izvodi, može se ponavljati, te je prikladna za djecju dob. Analiza izdahnutoga kondenzata omogucuje mjerenje koncentracije razlicitih plucnih sastojaka: kako nehlapljivih(oksidativni produkti, medijatori, proteini) tako i hlapljivih molekula (dusikov oksid, ugljicni monoksid, ugljicni dioksid). Ocekuje se da ce analiza izdahnutog kondenzata pomoci u diferencijalnoj dijagnozi razlicitih plucnih bolesti, kao sto su astma, kronicna opstruktivna plucna bolest, cisticna fibroza, broniektazije, intersticijska plucna bolest. U tu se svrhu u mnogim laboratorijima danas provode istraživanja dijagnosticke važnosti određivanja koncentracije interferona gama, leukotrijena, prostaglandina, interleukina. Osi...
Results of determination of circulating histamine releasing autoantibodies using histamine releas... more Results of determination of circulating histamine releasing autoantibodies using histamine release urticaria test in 12 children (aged 3 to 18 years, mean age 8.5 years ; 7 female and 5 male) with chronic urticaria are presented. Standard work-up including detailed history, allergy testing and routine laboratory findings did not disclose any plausible cause of chronic/recurrent urticarial eruption in these children. All children underwent serum-induced basophil histamine release urticaria test. At serum dilution of 12.5%, the mean percent of histamine liberation was 40.8% (range 18%-77% ; normal <16.5%), which indicated the presence of autoantibodies to FcepsilonRI and/or to the IgE-FcepsilonRI complex. The percent of histamine release did not correlate with patient age or duration and severity of symptoms. Thus the autoimmune basis of chronic urticaria was established. Associated antithyroid autoantibodies were found in two patients. Complete or partial remission was obtained wi...
Anaphylaxis to vaccines is rare; approximately once in one million doses Anaphylaxis usually occu... more Anaphylaxis to vaccines is rare; approximately once in one million doses Anaphylaxis usually occurs within the first 30 min after exposure, but sometimes it can take up to 4 h or longer Symptoms of anaphylaxis are polymorphic, but well systematized and should be readily recognized and carefully appreciated Anaphylaxis should be acutely treated with adrenaline, systemic corticosteroids, volume replacement, and antihistamines Twenty-four-hour hospital observation is indicated because a biphasic course is possible in anaphylaxis Diagnosis relies on skin testing with the culprit vaccine and its components, and where available, in vitro tests for the specific IgE to vaccine additives Anaphylaxis contraindicates further immunization with the culprit vaccine; in exceptional vital situations, a desensitization-immunization graded dose protocol may be attempted in an intensive care setting
Patients with successful autologous or allogeneic hematopoietic stem-cell therapy should get boos... more Patients with successful autologous or allogeneic hematopoietic stem-cell therapy should get booster courses of previous vaccinations Additionally, the patient should get inactivated Inf, PCV and Men vaccine Inactivated vaccines can generally be started at 6 months post HSCT, provided the child has no immunosuppression for the past 3 months, a lymphocyte count >1200/μL, and endogenous IgG > 500 mg/dL Live vaccines are strictly contraindicated. Only MMR and Var can be considered in select well engrafted cases, no sooner than 24 months after HSCT. Requirement is CD4+ count >700/mL, endogenous IgG >500 mg/dL, and adequate serological response to inactivated vaccines, no immunosuppression and no GVHD Passive immunoglobulin prophylaxis is established for measles by IVIG and for chickenpox by VZIG Chemoprophylaxis with valacyclovir is available for chickenpox, in intramuscular and subcutaneous forms The 16% HNIG concentrate can provide passive protection for measles, and to some extent hepatitis A and chickenpox
Archives of Industrial Hygiene and Toxicology, 2014
Mycotoxicoses are acute and chronic poisonings caused by mould toxins called mycotoxins. Although... more Mycotoxicoses are acute and chronic poisonings caused by mould toxins called mycotoxins. Although acute mycotoxicoses, caused by high mycotoxin levels in food are rare nowadays, they need to be described in order to inform physicians and other health care workers about their symptoms. Children are more sensitive to mycotoxins because of their lower body mass, higher metabolic rate, and underdeveloped organ functions and detoxication mechanisms. Some mycotoxicoses appear only in children, and some are more pronounced in children than in adults. Acute mycotoxicoses in children are reported poorly, mostly because they occur in the tropical regions with poor healthcare coverage. In developed countries healthcare authorities are more concerned about child exposure to low levels of mycotoxins with immunotoxic, genotoxic or carcinogenic properties
ABSTRACT Wraz z postępującym starzeniem się populacji europejskiej prawdopodobnie będzie następow... more ABSTRACT Wraz z postępującym starzeniem się populacji europejskiej prawdopodobnie będzie następował stały wzrost zachorowalności i zwiększenie nakładów finansowych na leczenie w populacji osób dorosłych. Tendencje te czynią zasadne przeprowadzenie przeglądu i rewizji możliwych strategii profilaktycznych, jakimi są szczepienia. Z uwagi na niedobór skoordynowanych programów szczepień u dorosłych istotny problem stanowi wdrażanie tej formy immunizacji w populacji dorosłych. W krajach Europy Zachodniej zaczęto uwzględniać konieczność rozszerzenia szczepień w tej grupie demograficznej. Problem ten w Europie Środkowej pozostaje słabo poznany i wciąż niedostatecznie opisany. W niniejszym artykule podsumowano dostępne dane, których analiza wskazuje na konieczność rozszerzenia kalendarza szczepień dorosłych w grupie krajów Europy Środkowej, należących do Stowarzyszenia Świadomej Postawy wobec Szczepień CEVAG (Central European Vaccination Awareness Group) (Bułgaria, Chorwacja, Czechy, Estonia, Węgry, Łotwa, Litwa, Rumunia, Słowacja, Słowenia i Turcja). Grupa CEVAG zaleca wdrożenie kalendarza szczepień dorosłych, który powinien obejmować szczepienia przeciwko chorobom o największej śmiertelności i zachorowalności w tej populacji. Kalendarz ten powinien być indywidualizowany w stosunku do indywidualnych potrzeb i priorytetów krajowych.As Europe&#39;s population ages, disease morbidity and treatment costs in the adult population are likely to rise substantially, making this a pertinent time to review and revise preventive strategies such as vaccination. Vaccine uptake remains a problem for adults and there is a lack of coordinated programmes for vaccination of adults. Countries in Western Europe have begun to identify the need to increase adult vaccination, but the situation in Central European countries remains poorly identified and inadequately described. This paper summarises the evidence to support the development of an adult vaccination calendar in the Central European Vaccination Awareness Group (CEVAG) member countries (Bulgaria, Croatia, the Czech Republic, Estonia, Hungary, Latvia, Lithuania, Romania, Slovakia, Slovenia and Turkey). CEVAG recommends the introduction of an adult vaccination calendar, which should include vaccination against diseases that represent a large burden in adults in terms of mortality and morbidity. This calendar could be modified to meet the priorities of individual countries.
Interleukin-12 receptor β1 (IL-12Rβ1) deficiency is the most common form of Mendelian susceptibil... more Interleukin-12 receptor β1 (IL-12Rβ1) deficiency is the most common form of Mendelian susceptibility to mycobacterial disease (MSMD). We undertook an international survey of 141 patients from 102 kindreds in 30 countries. Among 102 probands, the first infection occurred at a mean age of 2.4 years. In 78 patients, this infection was caused by Bacille Calmette-Guérin (BCG; n = 65), environmental mycobacteria (EM; also known as atypical or nontuberculous mycobacteria) (n = 9) or Mycobacterium tuberculosis (n = 4). Twenty-two of the remaining 24 probands initially presented with nontyphoidal, extraintestinal salmonellosis. Twenty of the 29 genetically affected sibs displayed clinical signs (69%); however 8 remained asymptomatic (27%). Nine nongenotyped sibs with symptoms died. Recurrent BCG infection was diagnosed in 15 cases, recurrent EM in 3 cases, recurrent salmonellosis in 22 patients. Ninety of the 132 symptomatic patients had infections with a single microorganism. Multiple infec...
European Journal of Clinical Microbiology & Infectious Diseases, 2011
Streptococcus pneumoniae causes considerable global paediatric morbidity and mortality, despite t... more Streptococcus pneumoniae causes considerable global paediatric morbidity and mortality, despite the availability of safe and effective pneumococcal conjugate vaccines (PCVs). To justify the introduction of PCVs, accurate information on the burden of disease is required. Here, we present an appraisal of the pneumococcal epidemiological situation in 11 Central European countries. The data are based on study findings presented at the 12th Central European Vaccine Advisory Group (CEVAG) meeting, held on 21-22 May 2010 in Sofia, Bulgaria, and a literature review of the PubMed database using the search terms &amp;amp;amp;#x27;pneumococcal&amp;amp;amp;#x27; or &amp;amp;amp;#x27;Streptococcus pneumoniae&amp;amp;amp;#x27;, in combination with &amp;amp;amp;#x27;otitis media&amp;amp;amp;#x27;, &amp;amp;amp;#x27;pneumonia&amp;amp;amp;#x27;, &amp;amp;amp;#x27;meningitis&amp;amp;amp;#x27; or &amp;amp;amp;#x27;bacteraemia/sepsis&amp;amp;amp;#x27;, and &amp;amp;amp;#x27;[Central European country name]&amp;amp;amp;#x27;. The incidence of pneumococcal disease appears to be lower in Central Europe than previously reported for Europe as a whole, with the highest risk in infants aged 0-2 years. The fatality rates in the under fives from invasive infections are up to 40%. A paucity of comprehensive country-specific data on pneumococcal disease burden arises from the lack of homogenous surveillance programmes. Standardised, active surveillance systems are required for the accurate evaluation of the pneumococcal disease burden in the region. Only then can the need for vaccination be addressed.
Acta medica Croatica : casopis Hravatske akademije medicinskih znanosti, 2011
Allergic rhinitis is the most prevalent form of chronic rhinitis in children. It is driven by all... more Allergic rhinitis is the most prevalent form of chronic rhinitis in children. It is driven by allergic inflammation and is commonly associated with other atopic diseases such as asthma and atopic eczema. The main allergens are primarily aeroallergens: house dust mite, and tree, grass and weed pollen. It is, however, not exceptional to experience symptoms of allergic rhinoconjunctivitis in conjunction with food allergy and oral food allergy syndrome, especially in infants and toddlers. Allergic rhinitis is often associated with allergic asthma, either preceding it, or developing later and making it more difficult to treat. The mainstay of treatment is exposure prophylaxis, antihistamines, leukotriene antagonists and intranasal corticosteroids. Allergic rhinitis is one of the prime indications for specific allergen immunotherapy, which may have a preventive effect on the development of asthma. Allergic rhinitis associated with intermittent or mild persistent asthma may be a good indic...
Results of determination of circulating histamine releasing autoantibodies using histamine releas... more Results of determination of circulating histamine releasing autoantibodies using histamine release urticaria test in 12 children (aged 3 to 18 years, mean age 8.5 years; 7 female and 5 male) with chronic urticaria are presented. Standard work-up including detailed history, allergy testing and routine laboratory findings did not disclose any plausible cause of chronic/recurrent urticarial eruption in these children. All children underwent serum-induced basophil histamine release urticaria test. At serum dilution of 12.5%, the mean percent of histamine liberation was 40.8% (range 18%-77%; normal <16.5%), which indicated the presence of autoantibodies to Fc epsilon RI and/or to the IgE-Fc epsilon RI complex. The percent of histamine release did not correlate with patient age or duration and severity of symptoms. Thus the autoimmune basis of chronic urticaria was established. Associated antithyroid autoantibodies were found in two patients. Complete or partial remission was obtained ...
SUMmARY An 8 year old girl with primary pulmonary hypertension and signs of heart failure was giv... more SUMmARY An 8 year old girl with primary pulmonary hypertension and signs of heart failure was given 17*5 mg of verapamil injected into the pulmonary artery over 25 minutes to test for the reversibility of pulmonary arteriolar obstruction. Pulmonary artery pressure fell from 70/50 to 35/25 mm Hg. Treatment with 40 mg verapamil by mouth four times daily was started, and she was discharged. She gradually became asymptomatic and resumed the activities of a normal child of school age. On recatheterisation seven months later her pulmonary artery pressure was 30/ 10 mm Hg. She was still doing well 12 months after the start of treatment. Primary pulmonary hypertension has a poor prog-nosis and is a frustrating problem for the managing physician. Calcium antagonists have smooth muscle relaxing properties ' and well known systemic vaso-dilator and antihypertensive effects.2 McMurtry et al showed on a rat lung model that calcium antagonists were capable of inhibiting the hypoxic pulmonary...
U radu prikazane su smjernice za lijecenje anafilaksije i anafilaktickog soka u djece koje je don... more U radu prikazane su smjernice za lijecenje anafilaksije i anafilaktickog soka u djece koje je donijela radna skupina Hrvatskog drustva za alergologiju i klinicku imunologiju.
Temporal association of an adverse event to immunization should not automatically be considered t... more Temporal association of an adverse event to immunization should not automatically be considered to constitute a causal relation If the events are not causally related, the continuation of immunization is advised Atopy and autoimmunity are not associated with history of immunization Comorbid disorders like multiple sclerosis, Guillain-Barre syndrome and thrombocytopenia may constitute relative or absolute contraindications to specific vaccines
Analiza izdahnutoga kondenziranog zraka zadnjih se godina opisuje kao moguca nova metoda u dijagn... more Analiza izdahnutoga kondenziranog zraka zadnjih se godina opisuje kao moguca nova metoda u dijagnostici i longitudinalnom pracenju plucnih bolesti. Uzorak izdahnutoga kondenzata dobije se vrlo jednostavno: izdisanjem zraka u rashlađeni spremnik. Metoda dobivanja uzorka je neinvazivna, lako se izvodi, može se ponavljati, te je prikladna za djecju dob. Analiza izdahnutoga kondenzata omogucuje mjerenje koncentracije razlicitih plucnih sastojaka: kako nehlapljivih(oksidativni produkti, medijatori, proteini) tako i hlapljivih molekula (dusikov oksid, ugljicni monoksid, ugljicni dioksid). Ocekuje se da ce analiza izdahnutog kondenzata pomoci u diferencijalnoj dijagnozi razlicitih plucnih bolesti, kao sto su astma, kronicna opstruktivna plucna bolest, cisticna fibroza, broniektazije, intersticijska plucna bolest. U tu se svrhu u mnogim laboratorijima danas provode istraživanja dijagnosticke važnosti određivanja koncentracije interferona gama, leukotrijena, prostaglandina, interleukina. Osi...
Results of determination of circulating histamine releasing autoantibodies using histamine releas... more Results of determination of circulating histamine releasing autoantibodies using histamine release urticaria test in 12 children (aged 3 to 18 years, mean age 8.5 years ; 7 female and 5 male) with chronic urticaria are presented. Standard work-up including detailed history, allergy testing and routine laboratory findings did not disclose any plausible cause of chronic/recurrent urticarial eruption in these children. All children underwent serum-induced basophil histamine release urticaria test. At serum dilution of 12.5%, the mean percent of histamine liberation was 40.8% (range 18%-77% ; normal <16.5%), which indicated the presence of autoantibodies to FcepsilonRI and/or to the IgE-FcepsilonRI complex. The percent of histamine release did not correlate with patient age or duration and severity of symptoms. Thus the autoimmune basis of chronic urticaria was established. Associated antithyroid autoantibodies were found in two patients. Complete or partial remission was obtained wi...
Anaphylaxis to vaccines is rare; approximately once in one million doses Anaphylaxis usually occu... more Anaphylaxis to vaccines is rare; approximately once in one million doses Anaphylaxis usually occurs within the first 30 min after exposure, but sometimes it can take up to 4 h or longer Symptoms of anaphylaxis are polymorphic, but well systematized and should be readily recognized and carefully appreciated Anaphylaxis should be acutely treated with adrenaline, systemic corticosteroids, volume replacement, and antihistamines Twenty-four-hour hospital observation is indicated because a biphasic course is possible in anaphylaxis Diagnosis relies on skin testing with the culprit vaccine and its components, and where available, in vitro tests for the specific IgE to vaccine additives Anaphylaxis contraindicates further immunization with the culprit vaccine; in exceptional vital situations, a desensitization-immunization graded dose protocol may be attempted in an intensive care setting
Patients with successful autologous or allogeneic hematopoietic stem-cell therapy should get boos... more Patients with successful autologous or allogeneic hematopoietic stem-cell therapy should get booster courses of previous vaccinations Additionally, the patient should get inactivated Inf, PCV and Men vaccine Inactivated vaccines can generally be started at 6 months post HSCT, provided the child has no immunosuppression for the past 3 months, a lymphocyte count >1200/μL, and endogenous IgG > 500 mg/dL Live vaccines are strictly contraindicated. Only MMR and Var can be considered in select well engrafted cases, no sooner than 24 months after HSCT. Requirement is CD4+ count >700/mL, endogenous IgG >500 mg/dL, and adequate serological response to inactivated vaccines, no immunosuppression and no GVHD Passive immunoglobulin prophylaxis is established for measles by IVIG and for chickenpox by VZIG Chemoprophylaxis with valacyclovir is available for chickenpox, in intramuscular and subcutaneous forms The 16% HNIG concentrate can provide passive protection for measles, and to some extent hepatitis A and chickenpox
Archives of Industrial Hygiene and Toxicology, 2014
Mycotoxicoses are acute and chronic poisonings caused by mould toxins called mycotoxins. Although... more Mycotoxicoses are acute and chronic poisonings caused by mould toxins called mycotoxins. Although acute mycotoxicoses, caused by high mycotoxin levels in food are rare nowadays, they need to be described in order to inform physicians and other health care workers about their symptoms. Children are more sensitive to mycotoxins because of their lower body mass, higher metabolic rate, and underdeveloped organ functions and detoxication mechanisms. Some mycotoxicoses appear only in children, and some are more pronounced in children than in adults. Acute mycotoxicoses in children are reported poorly, mostly because they occur in the tropical regions with poor healthcare coverage. In developed countries healthcare authorities are more concerned about child exposure to low levels of mycotoxins with immunotoxic, genotoxic or carcinogenic properties
ABSTRACT Wraz z postępującym starzeniem się populacji europejskiej prawdopodobnie będzie następow... more ABSTRACT Wraz z postępującym starzeniem się populacji europejskiej prawdopodobnie będzie następował stały wzrost zachorowalności i zwiększenie nakładów finansowych na leczenie w populacji osób dorosłych. Tendencje te czynią zasadne przeprowadzenie przeglądu i rewizji możliwych strategii profilaktycznych, jakimi są szczepienia. Z uwagi na niedobór skoordynowanych programów szczepień u dorosłych istotny problem stanowi wdrażanie tej formy immunizacji w populacji dorosłych. W krajach Europy Zachodniej zaczęto uwzględniać konieczność rozszerzenia szczepień w tej grupie demograficznej. Problem ten w Europie Środkowej pozostaje słabo poznany i wciąż niedostatecznie opisany. W niniejszym artykule podsumowano dostępne dane, których analiza wskazuje na konieczność rozszerzenia kalendarza szczepień dorosłych w grupie krajów Europy Środkowej, należących do Stowarzyszenia Świadomej Postawy wobec Szczepień CEVAG (Central European Vaccination Awareness Group) (Bułgaria, Chorwacja, Czechy, Estonia, Węgry, Łotwa, Litwa, Rumunia, Słowacja, Słowenia i Turcja). Grupa CEVAG zaleca wdrożenie kalendarza szczepień dorosłych, który powinien obejmować szczepienia przeciwko chorobom o największej śmiertelności i zachorowalności w tej populacji. Kalendarz ten powinien być indywidualizowany w stosunku do indywidualnych potrzeb i priorytetów krajowych.As Europe&#39;s population ages, disease morbidity and treatment costs in the adult population are likely to rise substantially, making this a pertinent time to review and revise preventive strategies such as vaccination. Vaccine uptake remains a problem for adults and there is a lack of coordinated programmes for vaccination of adults. Countries in Western Europe have begun to identify the need to increase adult vaccination, but the situation in Central European countries remains poorly identified and inadequately described. This paper summarises the evidence to support the development of an adult vaccination calendar in the Central European Vaccination Awareness Group (CEVAG) member countries (Bulgaria, Croatia, the Czech Republic, Estonia, Hungary, Latvia, Lithuania, Romania, Slovakia, Slovenia and Turkey). CEVAG recommends the introduction of an adult vaccination calendar, which should include vaccination against diseases that represent a large burden in adults in terms of mortality and morbidity. This calendar could be modified to meet the priorities of individual countries.
Interleukin-12 receptor β1 (IL-12Rβ1) deficiency is the most common form of Mendelian susceptibil... more Interleukin-12 receptor β1 (IL-12Rβ1) deficiency is the most common form of Mendelian susceptibility to mycobacterial disease (MSMD). We undertook an international survey of 141 patients from 102 kindreds in 30 countries. Among 102 probands, the first infection occurred at a mean age of 2.4 years. In 78 patients, this infection was caused by Bacille Calmette-Guérin (BCG; n = 65), environmental mycobacteria (EM; also known as atypical or nontuberculous mycobacteria) (n = 9) or Mycobacterium tuberculosis (n = 4). Twenty-two of the remaining 24 probands initially presented with nontyphoidal, extraintestinal salmonellosis. Twenty of the 29 genetically affected sibs displayed clinical signs (69%); however 8 remained asymptomatic (27%). Nine nongenotyped sibs with symptoms died. Recurrent BCG infection was diagnosed in 15 cases, recurrent EM in 3 cases, recurrent salmonellosis in 22 patients. Ninety of the 132 symptomatic patients had infections with a single microorganism. Multiple infec...
European Journal of Clinical Microbiology & Infectious Diseases, 2011
Streptococcus pneumoniae causes considerable global paediatric morbidity and mortality, despite t... more Streptococcus pneumoniae causes considerable global paediatric morbidity and mortality, despite the availability of safe and effective pneumococcal conjugate vaccines (PCVs). To justify the introduction of PCVs, accurate information on the burden of disease is required. Here, we present an appraisal of the pneumococcal epidemiological situation in 11 Central European countries. The data are based on study findings presented at the 12th Central European Vaccine Advisory Group (CEVAG) meeting, held on 21-22 May 2010 in Sofia, Bulgaria, and a literature review of the PubMed database using the search terms &amp;amp;amp;#x27;pneumococcal&amp;amp;amp;#x27; or &amp;amp;amp;#x27;Streptococcus pneumoniae&amp;amp;amp;#x27;, in combination with &amp;amp;amp;#x27;otitis media&amp;amp;amp;#x27;, &amp;amp;amp;#x27;pneumonia&amp;amp;amp;#x27;, &amp;amp;amp;#x27;meningitis&amp;amp;amp;#x27; or &amp;amp;amp;#x27;bacteraemia/sepsis&amp;amp;amp;#x27;, and &amp;amp;amp;#x27;[Central European country name]&amp;amp;amp;#x27;. The incidence of pneumococcal disease appears to be lower in Central Europe than previously reported for Europe as a whole, with the highest risk in infants aged 0-2 years. The fatality rates in the under fives from invasive infections are up to 40%. A paucity of comprehensive country-specific data on pneumococcal disease burden arises from the lack of homogenous surveillance programmes. Standardised, active surveillance systems are required for the accurate evaluation of the pneumococcal disease burden in the region. Only then can the need for vaccination be addressed.
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Papers by Darko Richter