Risk assessment of central nervous system (CNS) infection patients is of key importance in predicting likely pathogens. However, data are lacking on the epidemiology globally. We performed a multicenter study to understand the burden of community-acquired CNS (CA-CNS) infections between 2012 and 2014. A total of 2583 patients with CA-CNS infections were included from 37 referral centers in 20 countries. Of these, 477 (18.5%) patients survived with sequelae and 227 (8.8%) died, and 1879 (72.7%) patients were discharged with complete cure. The most frequent infecting pathogens in this study were Streptococcus pneumoniae (n = 206, 8%) and Mycobacterium tuberculosis (n = 152, 5.9%). Varicella zoster virus and Listeria were other common pathogens in the elderly. Although staphylococci and Listeria resulted in frequent infections in immunocompromised patients, cryptococci were leading pathogens in human immunodeficiency virus (HIV)-positive individuals. Among the patients with any proven etiology, 96 (8.9%) patients presented with clinical features of a chronic CNS disease. Neurosyphilis, neurobrucellosis, neuroborreliosis, and CNS tuberculosis had a predilection to present chronic courses. Listeria monocytogenes, Staphylococcus aureus, M. tuberculosis, and S. pneumoniae were the most fatal forms, while sequelae were significantly higher for herpes simplex virus type 1 (p < 0.05 for all). Tackling the high burden of CNS infections globally can only be achieved with effective pneumococcal immunization and strategies to eliminate tuberculosis, and more must be done to improve diagnostic capacity.

Background/Aim. The World Health Organization estimates that 3.2 billion people are at a risk of being infected with malaria. Thus, the adequate diagnostic protocols for malaria, especially those aimed at determining disease severity, are paramount both in endemic and non-endemic setting. The aim of this study was to identify the demographic, parositological, clinical and laboratory characteristics associated with severe malaria in a non-endemic settings. Methods. We analyzed 22 patients with severe malaria and compared their clinical and laboratory findings with those of the patients with non-severe malaria in a search of predictors of disease severity. All patients were treated at the Infectious and Tropical Diseases University Hospital, Clinical Centre of Serbia in Belgrade, Serbia from 2000 to 2010. Results. The average age of patients with with severe malaria was 44.86 ± 12.33 years and men predominated (95.45%). The patients with severe malaria were infected Plasmodium falciparum (P. falciparum) significantly more frequently compared with those with non-severe disease (p =0.047). Jaundice was the most commonly observed feature of severe malaria, followed by anemia and renal failure. The multifactor analysis of variance showed that thrombocytopenia (p = 0.05) and high serum tumor necrosis factor-alpha levels (p = 0.02) were significantly associated with the disease severity. Conclusion. A high index of suspicion for malaria should be maintained when evaluating febrile patients returning from the malaria endemic regions. The elevated serum tumor necrosis factor-alpha levels and thrombocytopenia are associated with severe malaria in non-endemic settings. Apstrakt Ključne reči: malarija; faktor nekroze tumora-alfa; trombocitopenija; bolesti, indeks težine; srbija. Vol. 76, No 5 VOJNOSANITETSKI PREGLED Page 471 Poluga J, et al. Vojnosanit Pregl 2019; 76(5): 470-475.

Introduction. Chickenpox is a common pediatric disease, while herpes zoster (HZ) is rare among children, especially among infants. HZ in infancy may appear after intrauterine or postnatal infection with varicella-zoster virus (VZV). We report on a case of HZ in an immunocompetent infant who had a history of chickenpox in early infancy. Case outline. A seven-month-old male infant was presented with skin changes in the left T1 and T2 dermatomes. Skin changes appeared eight days after the infant had a mild left-arm traction injury. The patient?s medical history revealed that he had a mild form of chickenpox at the age of three and a half months. After the clinical diagnosis of HZ was made, he was treated with oral acyclovir 20 mg/kg every six hours for five days and had complete recovery without any sequelae. Conclusion. Risk factors for pediatric HZ are immunosuppression and chickenpox during the first year of life. Local trauma is a reported risk for VZV reactivation among adults. To our best knowledge, our case is the first reported pediatric case in which the injury of the left arm precedes HZ appearance. Routine vaccination against chickenpox may be an important preventive measure because herd immunity will protect infants and immunocompromised children from getting chickenpox and thus HZ.