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The primary objectives of this study were (1) to determine the presence of Borrelia burgdorferi infection in ticks removed from patients for the purpose of singling out sites with increased risk of Lyme borreliosis, and (2) to determine the presence of IgM and/or IgG antibodies against B. burgdorferi sensu lato (s. l.) complex in sera of patients who had ticks removed. From 108 ticks removed from patients, all were examined zoologically and a sub-sample of 91 ticks was tested using PCR analysis to determine the presence of DNA indicating B. burgdorferi infection. To detect anti-Borrelia IgM and/ or IgG antibodies in 61 patients bitten by ticks, we used line recombinant immunoblot test. The most common tick identified was Ixodes ricinus. B. burgdorferi s. l. was present in 37 of 91 tested ticks (40.7%). Seroconversion against B. burgdorferi s. l. antigen was detected in 12 of 61 patients (19.7%). Most of the infected ticks were from the province of Vojvodina (11 municipalities), with the city of Novi Sad proving to be the site with the highest number of infected ticks, 6 in total. Glavni cilj ove studije je bio da se ispita prisustvo B. burgdorferi infekcije u krpeljma uklonjenih sa pacijenata radi utvđivanja lokaliteta sa povećanim rizikom za obolevanje od lajm borelioze, kao i ispitivanje prisustva IgM i/ili IgG antitela usmerenih protiv B. burgdorferi s. l. kompleksa u serumu pacijenata infestiranih krpeljima. Sa pacijenata je prikupljeno i zoološki ispitano 108 krpelja. PCR analiza krpelja korišc'ena je za utvrđivanje prisustva B. burgdorferi s. l. kompleks kod 91 krpelja od ukupnih 108. Za otkrivanje IgM i/ili IgG antitela protiv B. burgdorferi s. l. korišćeni su linijski rekombinantni imunoblot testovi. Najčešc'i identifikovani krpelj je Ixodes ricinus. B. burgdorferi s. l. je bila prisutna u 37 od 91 testiranog krpelja (40,7%). Prisustvo IgM/IgG antitela protiv B. burgdorferi s. l. otkriveno je kod 12 od 61 pacijenta (19,7%). Najviše inficiarnih krpelja je sa teritorije AP Vojvodine (11 opština), gde je urbani deo Novog Sada lokalitet sa najvećim brojem inficiranih krpelja - 6.

Lajmska borelioza je najčešća bolest prenosiva krpeljima u Srbiji i drugim zemljama Evrope. Uprkos naporima da se poboljša kontrola lajmske borelioze, u poslednjim decenijama ova zoonoza je i dalje najraprostranjenija bolest koju prenose artropode u velikom broju regiona severne hemisfere. Računanje incidence lajmske borelioze na tlu Evrope predstavlja izazov, s obzirom da u više zemalja lajm borelioza ne podleže prijavljivanju, što je i slučaj u R. Srbiji u poslednjih nekoliko godina. Smatra se da će lajmska borelioza postati sve relevantniji zdravstveni rizik u bliskoj budućnosti zbog složenih interakcija između različitih uslova spoljašnje sredine i socio-ekonomskih faktora, koji će uticati na različite aspekte epidemiologije bolesti, kao i ekologije rezevoara i vektora borelija. Kliničke manifestacije lajmske boreloze predstavljaju jasno definisane simptome i znakove od kojih su mnogi prolazni, usled čega može doći do razvoja hroničnih i teških, napredujućih i nepovratnih promena usled neblagovremenog reagovanja. Učinjeni su značajni napori u cilju standardizacije dijagnostičkih protokola lajmske borelioze na tlu Evrope. Usled nestandardizovanog tretmana pacijenata infestoranih krpeljima u Republici Srbiji, prisutan je dvostruki rizik: da je upitna validnost mnogih dijagnoza lajmske borelioze postavljenih na osnovu pozitivnih laboratorijskih nalaza i nejasne kliničke slike u proteklim godinama, kao i mogućnost da postoje oboleli pacijenti kod kojih nije blagovremeno dokazana lajmska borelioza usled negativnih laboratorijskih nalaza. Ciljevi istraživanja su utvrđivanje efekata demografskih karakteristika pacijenatai efekat godišnjeg doba na izlaganje ubodu krpelja i obolevanje od rane faze lajmske borelioze, kao i ispitivanje pozitivne i negativne prediktivne vrednosti seroloških i molekularnih skrining testova u dijagnostici rane faze lajmske borelioze kod osoba koje je infestirao krpelj naspram fizikalnog pregleda kao zlatnog standarda za postavljanje dijagnoze. Rezultati ovog istraživanja ukazuju na to da: Starosne kategorije dece i odraslih su češće izlagane napadima krpelja i mogu se smatrati rizičnim kategorijama naspram adolescenata i starijih osoba za infestaciju krpeljima. Starost ne predstavlja faktor rizika za obolevanje od rane faze lajmske borelioze. Kao godišnje doba sa najvećim rizikom za infestaciju krpeljima identifikovano je proleće. Meseci sa najvećim rizikom za obolevanje od rane faze lajmske borelioze su maj, jun i jul. Tip naselja u kome osoba živi ne predstavlja faktor rizika za izlaganje krpeljima i obolevanje od rane faze lajmske borelioze kod stanovništva Južnobačkog okruga. Pozitivna prediktivna vrednost seroloških skrining testova u dijagnostici prve faze lajmske borelioze kod osoba infestiranih krpeljima je niska i ne treba se koristiti kao zamena za fizikalni pregled koji je zlatni standard. Negativna prediktivna vrednost seroloških skrining testova kod stanovnika Južnobačkog osoba infestiranih krpeljima je visoka. Serološki skining testovi mogu imati koristi prilikom diferencijalno-dijagnostičkog otpisivanja mogućeg obolevanja od rane faze lajmske borelioze kod stanovnika Južnobačkog okuga. Pozitivna prediktivna vrednost molekularnih skrining testova krpelja na prisustvo DNK B. burgdorferi s. l. u dijagnostici rane faze lajm borelioze je viša od pozitivnih prediktivnih vrednosti seroloških skrining testova, ali nedovoljno visoka da bi se analiza mogla koristiti kao zamena za fizikalni pregled koji je zlatni standard. Negativna prediktivna vrednost molekularnih skrining testova krpelja na prisustvo DNK B. burgdorferi s. l. u dijagnostici rane faze lajmske borelioze je viša od negativnih prediktivnih vrednosti seroloških skrining testova i može se koristiti tokom diferencijalno-dijagnostičkog otpisivanja mogućeg obolevanja od rane faze lajmske borelioze. Lyme borreliosis is the most common tick-borne disease in Serbia and other European countries. Despite efforts to improve control of Lyme borreliosis, in recent decades this zoonosis has remained the most widespread disease transmitted by arthropods in many regions of the northern hemisphere. Calculating the incidence of Lyme borreliosis in Europe is a challenge, given that in several countries Lyme borreliosis is not subject to reporting, which is the case in the Republic of Serbia in the last few years. Lyme borreliosis is thought to become an increasingly relevant health risk in the near future due to complex interactions between different environmental conditions and socioeconomic factors, which will affect different aspects of the disease epidemiology, as well as the ecology of reservoirs and Borrelia vectors. Clinical manifestations of Lyme borrelosis are clearly defined symptoms and signs, many of which are transient, which can lead to the development of chronic and severe, progressive and irreversible changes due to untimely response. Significant efforts have been made to standardize diagnostic protocols for Lyme borreliosis in Europe. Given that management of Lyme borreliosis in the Republic of Serbia is non-standardized, there is a double risk: that the validity of many diagnoses of Lyme borreliosis positive laboratory findings and unclear clinical picture in recent years, as well as the possibility that there are patients in whom Lyme borreliosis has not been proven in a timely manner due to negative laboratory findings. The objectives of the study are to determine the effects of demographic characteristics of patients and the effect of the season on exposure to tick bites and early stage Lyme borreliosis, as well as to examine the positive and negative predictive value of serological and molecular screening tests in diagnosing early stage Lyme borreliosis in infected individuals. compared to physical examination of the patient as the current gold standard for diagnosis. The results of this research indicate that: Age categories of children and adults are more often exposed to tick infestation and can be considered risk categories compared to adolescents and the elderly for tick infestation. Age is not a risk factor for early-stage Lyme borreliosis. Spring has been identified as the season with the highest risk of tick infestation. The months with the highest risk of developing early-stage Lyme borreliosis are May, June and July. The type of settlement in which a person lives is not a risk factor for tick exposure and early stage Lyme borreliosis in the population of South-Bačka District. The positive predictive value of serological screening tests in the diagnosis of the first phase of Lyme borreliosis in persons infested with ticks is low and should not be used as a substitute for physical examination, which is the current gold standard. The negative predictive value of serological screening tests in the South-Bačka District residents infested with ticks is high. Serological skinning tests can be useful in the differential diagnostic ruling out of possible Lyme borreliosis. Positive predictive value of tick molecular screening tests for the presence of B. burgdorferi s. l. DNA in the diagnosis of early stage Lyme borreliosis is higher than the positive predictive values of serological screening tests, but not high enough for the analysis to be used as a substitute for physical examination, which is the gold standard. Negative predictive value of tick molecular screening tests for the presence of B. burgdorferi s. l. DNA in the diagnosis of the early phase of Lyme borreliosis is higher than the negative predictive values of serological screening tests and can be used during the differential diagnostic ruling out of possible Lyme borreliosis.

U periodu od 2015. do 2018. godine ispitane su 223 lisice i 64 šakala sa područja Vojvodine Parazitološkim pregledom konstatovano je prisustvo 9 vrsta crevnih helminata, od toga jedna vrsta metilja (Alaria alata), četiri vrste pantljičara (Mesocestoides spp., Ecinococcus multilocularis, Taenia pisiformis, Taenia hydatigena) i četiri vrste nematoda (Toxocara canis, Toxascaris leonina, Uncinaria stenocephala, Pterygodermatites affinis). Nematoda Pterygodermatites affinis je prvi put zabeležena u Vojvodini. Izolovane su 4483 jedinke parazita, od toga 3826 kod lisica i 657 kod šakala. Zabeležena je veća zaraženost lisica (79.8%) u odnosu na šakale (57.8%) (p=0.0003). Najveći procenat obe vrste domaćina (Vulpes vulpes - 49.3%; Canis aureus - 42.2%) bio je zaražen pantljičarama roda Mesocestoides. Kod obe vrste domaćina, vrednosti Berger-Parkerovog indeksa ukazale su na relativno ujednačenu respodelu parazita po vrstama u ukupnom uzorku, dok su sva tri indeksa (Šenonov, Simpsonov i Berger-Parkerov) pokazala su da je područje Bačke sa najvišim biodiverzitetom zajednica helminata. Za vrste Echinococcus multilocularis i Alaria alata utvrđena je statistički značajna razlika u procentu inficiranih lisica u zavisnosti od područja Vojvodine. Prema taksonomskoj strukturi helmintofaune kod lisica je dokazana najveća procentualna zastupljenost mešovite infekcije (61%), dok se broj vrsta po domaćinu kretao od 1 do 5. Registrovane su 42 različite kombinacije vrsta parazita. Kod šakala se takođe najčešće javljala mešovita infekcija (59%), dok se broj vrsta po domaćinu kretao od 1 do 4. Registrovano je 11 kombinacija crevnih parazita. Koprološki test se u ovom istraživanju pokazao kao nisko osetljiv i manje specifičan za identifikaciju parazita u odnosu na direktan pregled intestinuma nakon autopsije životinje. Prevalenca infestiranih lisica (56.3%) i šakala (48%) dokazana koprološkom metodom manja je u odnosu na prevalencu prema patološkom nalazu. Kod obe vrste domaćina nije registrovan statistički značajan uticaj pola na prevalencu infekcije. Od identifikovanih vrsta helminata lisica i šakala, više od polovine njih ima zoonotski ili potencijalni zoonotski značaj: Alaria alata, Mesocestoides spp., Echinococcus multilocularis, Toxocara canis i Uncinaria stenocephala. Najvažnija među njima je pantljičara E. multilocularis, uzročnik ehinokokoze, bolesti svrstane na listu zoonoza od prioriteta na području Srbije. Na području Srema dokazana je pojava žarišta multilokularne ehinokokoze, zbog čega je neophodna optimizacija strategije za kontrolu širenja date vrste parazita., During the period from 2015. to 2018. year, 223 red foxes and 64 jackals from the area of Vojvodina were examined. Parasitological examination revealed 9 species of intestinal helminths, thereof one species of fluke (Alaria alata), four species of tapeworms (Mesocestoides spp., Ecinococcus multilocularis, Taeniapisiformis, Taenia hydatigena) and four species of nematodes (Toxocara canis, Toxascaris leonina, Uncinaria stenocephala, Pterygodermatites affinis). The nematode Pterygodermatites affinis was recorded in Vojvodina for the first time. There were isolated 4483 individuals of the parasite, thereof 3826 at red foxes and 657 at jackals. The higher infestation of foxes (79.8%) compared to jackales (57.8%) (p=0.0003) was recorded. The highest percentage of both hostspecies (Vulpes vulpes- 49.3%; Canis aureus- 42.2%) was infected with tapeworms of the genus Mesocestoides. In both host species, the value of the Berger-Parker index indicated a relatively uniform distribution of parasites by species in the total sample, while all three indices (Shannon, Simpson and BergerParker) showed that the area of Bačka had the highest biodiversity of helminth community. For the species Echinococcus multilocularis and Alaria alata was confirmed a statistically significant difference in the percentage of infected foxes depending on the area of Vojvodina. According to the taxonomic structure of helminth fauna, in foxes was proven the highest percentage of mixed infection (61%), while the number of species per host ranged from 1 to 5. There were registered 12 different combinations of parasite species. In jackals, the mixed infection was also the most common (59%), while the number of species per host ranged from 1 to 4. There were also registered 11 combinations of intestinal parasites. The coprologic test in this study proved to be low sensitiv and less specific for identification of parasites compared to direct examination of the intestine after autopsy of the animal. The prevalence of infested foxes (56.3%) and jackals (48%) proven by the coprological method was lower compered to the prevalence of patological finding. The statistically significant influence of sex on the prevalence of infection was not registered in neither one of the host species. Of the identified species of helminths, at foxes and jackals, more than half of them have zoonotic or potential zoonotic significance: Alaria alata, Mesocestoides spp., Echinococcus multilocularis, Toxocara canis i Uncinaria stenocephala. The most important among them is the tapeworm E. multilocularis, the cause of echinococcosis, a disease classified as a zoonosis of priorities in Serbia. In the area of Srem, the occurence of foci of multilocular ecinococcosis was proved, which is why it is necessary to optimize the strategy to control the spread of parasites.