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A retrospective study of the course and outcome of trichinellosis in a series of 50 patients hospitalized at the Institute for Infectious and Tropical Diseases in Belgrade between 2001 and 2008 was performed. Clinical diagnosis of trichinellosis was based upon the patients’ clinical history, symptoms and signs, and eosinophilia. The occurrence of cases showed a strong seasonality (P < 0.0001). The incubation period ranged between one and 33 days. The mean time between onset of symptoms and admission was nine days. Family outbreaks were the most frequent. Smoked pork products were the dominant source of infection (76 %). Fever was the most frequent clinical manifestation (90 %), followed by myalgia (80 %) and periorbital edema (76 %). 43 patients were examined serologically and 72 % of them had anti-Trichinella antibodies. Eosinophilia and elevated levels of serum CK and LDH were detected in 94, 50 and 56 % of the patients, respectively. All patients responded favorably to treatment with mebendazole or albendazole, but eight developed transient complications. Trichinellosis remains a major public health issue in Serbia.

Introduction. There is a rise of visceral leishmaniasis in immunocompromised patients due to increased availability of immunomodulatory drugs. In order to point at the occurrence of visceral leishmaniasis in patients with inflammatory bowel disease (IBD), we reported a case of female patient with a travel history to European Mediterranean countries, who was on immunosuppressive treatment due to ulcerative colitis. Case report. A 29-year-old female patient was admitted to hospital due to severe relapse of ulcerative colitis. Corticosteroid therapy was administered in addition to previous longterm azathioprine, with clinical response to the treatment. During the course of the disease she had recurrent high-grade fever with marked hepatosplenomegaly and pancytopenia. The diagnosis of leishmaniasis was established by positive serology tests and microscopic finding of amastigotes in bone marrow smears. The disseminated infection was responsive to treatment with liposomal amphotericin B, but therapy had to be discontinued due to urticarial rush. Subsequent therapy with antimony was administered, but it had to be stopped too due to liver toxicity. No further treatment for leishmaniasis was initiated as the clinical and laboratory data suggested that the patient had responded to the treatment. She was discharged from hospital in IBD remission and without signs of the infection. Conclusion. Visceral leishmaniasis should be considered in IBD patients with fever of unknown origin and relevant travel history in order to achieve favorable disease outcome.

Introduction. Trichinellosis is one of the most important foodborne diseases in Serbia. Most patients with suspected trichinellosis in Belgrade are referred to the Clinical Center of Serbia for diagnosis and treatment, as are unclear and complicated cases from all across Serbia. Materials and Methods. A retrospective study of trichinellosis serology was carried out from 2009-2018 and included all outpatients and hospitalised patients from the Clinic for Infectious and Tropical Disease, Clinical Center of Serbia, who were serologically tested for Trichinella by the Parasitological Laboratory (n=1,565). Trichinella-specific IgG antibodies were detected in sera by a commercial ELISA test. We analysed the seroprevalence of Trichinella-specific IgG antibodies, antibody detection kinetics and cross-reactivity with other nematodes. Results and Conclusions. The number of patients who reported for serological testing varied greatly per year and month. Most patients were tested in December and March, which coincides with the months with the most confirmed cases of trichinellosis. A total of 17.4% patients who were tested for trichinellosis had other parasitic infections. Altogether, 223 (14.2%) of tested patients were finally diagnosed with trichinellosis. We detected anti-Trichinella IgG in 68.8% (223) of patients with suspected trichinellosis on admission, which increased to 86.5%, 91.5% and 92.4% after later second, third and fourth testing, respectively. Final diagnoses of toxocariasis, strongyloidiasis, filariasis, and dirofilariasis were made for 2.4%, 0.3%, 0.3% and 0.1% of patients, respectively. Concurrent seropositivity for Trichinella and Toxocara was observed in 18.9% (7/37) of patients with clinical presentation of trichinellosis and who were also tested for toxocariasis. In 3/5 patients with imported filariasis, we found cross-reactivity with Trichinella. Potential cross-reactivity of this ELISA test with antibodies to the autochthonous nematode Toxocara canis demands the introduction of Western blot technology. Trichinellosis must be diagnosed by the combination of clinical, laboratory and epidemiological criteria.

Trichinellosis is the most common and most important parasitic zoonosis in Serbia. Complications of this disease are frequent, and a fatal outcome is possible. A particularly significant complication is the involvement of the central nervous system – neurotrichinellosis. This case report presents a previously healthy, 51-year-old female from Belgrade, Serbia, a teacher by profession. The disease started with symptoms of gastroenteritis in April, after which symptoms and signs characteristic of trichinellosis occurred (myalgia, fever, bilateral eyelid edema, conjunctivitis). About two weeks before the onset of the first symptoms, the patient consumed pork sausages that had been purchased at a green market. Seven days after the disease started, she was hospitalized at the Clinic for Infectious and Tropical Diseases in Belgrade and the diagnosis of trichinellosis was established. Two days after admission, neurological symptoms appeared – confusion, apathy, right side weakness of the mimic and limb muscles. The medical imaging techniques (CT scan, MRI) showed multiple hypodense changes in different parts of the brain, which corresponded to vasculitis due to parasitic infection. She was treated with approved antiparasitic and corticosteroid therapy. Despite adequate treatment, neurological sequelae were maintained in the follow-up period, and control imaging techniques revealed residual changes in the brain. This case emphasizes the importance of the strict application of all foreseen preventive measures in the control of trichinellosis, and primarily, mandatory trichinoscopic examination of all meat intended for human consumption.

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.

Introduction. The number of humans infected by Fasciola hepatica is increasing worldwide. Humans can become accidental hosts by ingesting drinking water or plants contaminated with metacercariae. Case report. We reported a case of a 68-year-old Serbian woman, in which the diagnosis of acute fasciolosis had been established after serious diagnostic concerns. Based on clinical picture (episodic right upper quadrant abdominal pain, febrility and generalized body pain) and biochemical analyses (high eosinophilia and high activity of alkaline phosphatase), she was appointed as suspected to the acute fasciolosis. Stool and duodenal aspirate exams were negative for Fasciola ova. In the absence of adequate serologic diagnostic for fasciolosis in Serbia, the diagnosis was confirmed using enzyme immunoassays and immunoblot at the Institute for Tropical Diseases in Hamburg, Germany. Soon after triclabendazole was administered, the symptoms disappeared and biochemical values returned to normal. Conclusion. The diagnosis of human fasciolosis may be problematic and delayed, especially in non endemic areas, because physicians rarely encounter this disease and a long list of other diseases must be considered in the differential diagnosis. The syndrome of eosinophilia, fever, and right upper quadrant abdominal pain suggest acute fasciolosis. Unclear source does not rule out fasciolosis.

Introduction. Cryptosporidiosis is an acute infectious parasitic disease of the gastrointestinal tract, considered as zoonosis underestimated in immunocompetent population. The pathogen is primarily the cause of devastating diarrhea in AIDS patients. Solitary cases and small outbreaks in immunocompetent persons are rarely discovered. There is also a human strain of cryptosporidium. Case Outline. In December 2010, we examined three family members among whom each successively developed acute gastroenteritis. Their stools were liquid, light brown, without mucus or blood. All of them had abdominal cramps and generalized muscle pains. The daughter had fever and vomited during the first two days. The patients were administered symptomatic therapy. Complaints resolved after 10-17 days, with general condition moderately changed. Cryptosporidium was confirmed in the stool of patients who were second and third to contract the disease. We presumed that the first person released pathogen before the time of examination, although she still had diarrhea. All of them recovered completely. By epidemiologic survey we were unable to presume with certainty the source of infection. Conclusion. This is the first description of cryptosporidiosis in immunocompetent individuals in Serbia, which proves that it is present in our country, and that search for it should be included into a routine parasitological check-up of stool. Taking into account the distance in onset time complaints, all combinations are possible; from infection among family members (shortest incubation period) to family members infected from an identical source (different incubation period). Negative finding of the sample collected on the 7th day from the beginning of symptoms does not exclude the diagnosis in this particular situation. Further epidemiologic studies of this disease are necessary as it is clear that it exists in our population. At that moment we were unable to do typization.

Natural habitats on the territory of Novi Sad are almost fully destroyed today, as well as their characteristic plant taxa. The reason for disappearance of natural habitats is the development of suburban communities, which is an irreversible process. Plant taxa, specific for wet, salty, and sandy ecosystems grew on those habitats twenty years ago and earlier. This paper presents the overview of 9 taxa (Suaeda maritima subsp. maritima, Androsace elongata subsp. elongata, Cirsium boujartii subsp. boujartii, Aster sedifolius subsp. canus, Blackstonia perfoliata subsp. serotina, Plantago maritima subsp. maritima, Salvia nutans, Allium angulosum, and Typha schuttleworthii). These taxa presented integral parts of autochthonous flora of Novi Sad. Since some of these taxa were found in the field 21 years ago and some even 93 years ago, they are extinct from the flora of Novi Sad.

In malaria, blood concentrations of proinflammatory cytokines, such as tumor necrosis factor alpha (TNF-α) and interleukin (IL)-6, are increased. In a study which included 34 patients, TNF-α and IL-6 were examined in two phases, immediately after the admission of patients, and at the end of antimalarial therapy, when the parasitemia was negative. The results show a significant increase of TNF-α and IL-6 in the first phase, before the effects of antimalarial therapy. A very strong correlation between TNF-α and IL-6 is also confirmed, which suggests their coordinated production. Increased TNF-α values were correlated with an older age, the level of parasitemia, the number of platelets and leukocytes, elevated values of procalcitonin, D-dimer and lactate dehydrogenasе, and lower values of serum iron and antithrombin. Increased values of IL-6 were correlated with the level of parasitemia, the number of platelets and leukocytes, and elevated values of D-dimer and lactates.

Extra pulmonary tuberculosis (EPTB) is a growing problem worldwide. Due to the nature of the disease, the diversity of clinical pictures as well as its minor epidemiological importance, the diagnosis is difficult and often late.In addition to standard TB diagnostic techniques use of new biochemical (surrogate markers) are increased. With this work we wanted to examine the usefulness of serum adenosine deaminase levels as a diagnostic parameter for EPTB.The work included 116 patients with fever of unknown origin in which tuberculosis or infectious mononucleosis was not proven and 51 person who had proven EPTB. Correlated adenosine deaminase levels between these two groups we obtained significantly higher values ​​in patients with EPTB. The calculated sensitivity was 0.56, specificity 0.89, positive predictive value 0.80 and negative predictive value 0.72. Certain reducing of the values observed during anti TB therapy. In previous studies the diagnostic importance of adenosine deaminase in the diagnosis of tuberculosis serosityes was demonstrated. The significance of serum levels in diagnosis is rarely evaluated during EPTB. Our findings are similar to the results of authors who have conducted such testing in the pediatric population.Increased concentrations of serum adenosine deaminase have shown the potential of usable screening test and can be used as an indicative EPTB parameter. To fully assess its diagnostic significance require future clinical research.

Fasciolosis is a zoonotic infection caused by the trematoda Fasciola hepatica and Fasciola gigantica. Human fasciolosis is endemic in some parts of South America, Africa, Eastern Asia and Europe. High prevalence of human fasciolosis does not necessarily occur in areas where fasciolosis is a major veterinary problem. Infection with Fasciola hepatica has not been reported in humans in Serbia and former Yugoslavia, although a large variety of animals, such as sheep and cattle show infection rates that may reach significant proportions in some areas. Humans can become accidental hosts of this parasite by ingesting contaminated drinking water or plants in an endemic area. Infection with Fasciola hepatica has a variable clinical presentation depending on the stage of the disease. Typical symptoms that may be associated with fascioliasis can be divided by the phases of the disease including the acute or liver phase, the chronic or biliary phase, the obstructive phase, and ectopic or pharyngeal fascioliasis. The diagnosis of human fasciolosis may be problematical and delayed, especially in non-endemic areas, because physicians rarely encounter this disease and a long list of other diseases must be included in the differential diagnosis. The diagnosis of fasciolosis is complex and requires the application of direct an indirect methods of diagnostics: clinical diagnosis, haematological and biochemical findings, parasitological diagnosis, immuno-diagnosis, imaging procedures, liver biopsy. At the Clinic for Infectious and Tropical Diseases in 2005, we recorded the first case of human fasciolosis in a woman from Belgrade, a citizen of Serbia, who developed clinical symptoms of acute fasciolosis after several months of living in Bosnia-Herzegovina. This article reviews the epidemiology and diagnostics of human fasciolosis. .

Objectives: As is the case for all of Southeast Europe, Serbia is an area traditionally endemic for Taenia saginata and Taenia solium infections. This study was performed to analyse the epidemiological data on taeniosis and cysticercosis in Serbia for the period 1990-2018., Methods: Data on cases of T. saginata and T. solium infection were collected via a systematic search of published articles, the grey literature, and official reports, as well as by performing clinical observational studies of patients treated in the departments for infectious diseases of hospitals and university clinics in Serbia., Results: A total of 212 cases of taeniosis were reported, all between 1997 and 2004 when taeniosis was notifiable (incidence range 0.04-0.9/100 000 population/year). From 1990 to 2018, 170 cases of cysticercosis (all but one of neurocysticercosis), were registered (incidence range 0-0.29/100 000 population/year), with a strong decrease since 2000 and a single case in the last 9 years. The annual number of cases of both taeniosis (Pearson's r = 0.914, p =  0.001) and cysticercosis (Pearson's r = 0.582, p = 0.014) correlated with the consumer price index., Conclusions: In Serbia, T. saginata and T. solium infections are autochthonous but occur only sporadically. However, the potential for re-emergence exists, depending on the socio-economic state of the country., (Copyright © 2019 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

In the original article [1], the authors Dr Jasmin OMERAGIĆ and Dr Davor ALAGIĆ were erroneously omitted from the co-authors list.

Background: Taenia solium and Taenia saginata are food-borne parasites of global importance. In eastern Europe only fragmented information is available on the epidemiology of these zoonotic parasites in humans and animal populations. In particular for T. solium, on-going transmission is suspected. The aim of this systematic review was to collect the available data and describe the current knowledge on the epidemiology of T. solium and T. saginata in eastern Europe., Methods: Literature published in international databases from 1990 to 2017 was systematically reviewed. Furthermore, local sources and unpublished data from national databases were retrieved from local eastern European experts. The study area included 22 countries., Results: Researchers from 18 out of the 22 countries provided data from local and unpublished sources, while no contacts could be established with researchers from Belarus, Kosovo, Malta and Ukraine. Taeniosis and human cysticercosis cases were reported in 14 and 15 out of the 22 countries, respectively. Estonia, the Former Yugoslav Republic of Macedonia, Lithuania, Moldova, Poland, Romania, Serbia, and Slovakia reported cases of porcine cysticercosis. Croatia, Czech Republic, Estonia, Former Yugoslav Republic of Macedonia, Moldova, Poland, Romania, Serbia, Slovakia, and Ukraine reported bovine cysticercosis., Conclusions: There is indication that taeniosis and cysticercosis are present across eastern Europe but information on the occurrence of T. solium and T. saginata across the region remains incomplete. Available data are scarce and species identification is in most cases absent. Given the public health impact of T. solium and the potential economic and trade implications due to T. saginata, notification of taeniosis and human cysticercosis should be implemented and surveillance and notification systems in animals should be improved.

Introduction: Retrospective molecular identification of Leishmania parasites in two patients with visceral leishmaniasis (VL) previously treated in Serbia was carried out. DNA was isolated from unstained bone marrow smears (BMSs) kept for 11 and 8 years. Genus-specific real-time PCR was combined with conventional PCR and sequencing for detection and species identification., Case Presentation: In 2003, a 40-year-old Serbian male was admitted to the Clinical Centre of Serbia (CCS) with fever, sweating, fatigue and splenomegaly, which developed over a period of 7 weeks. He had frequently travelled around Europe. VL was confirmed by microscopy of Giemsa-stained BMS. Treatment by pentavalent antimonials was successfully completed. Two years later, the patient developed post-kala-azar dermal leishmaniasis. Treatment resulted in symptom resolution. Later on, Leishmania infantum was identified as the causative agent of the VL by sequencing of the ITS (internal transcribed spacer) region; mixed Leishmania spp. infection could not be excluded. In 2006, a 33-year-old female from Vojvodina, Serbia, with pre-existing diabetes mellitus and chronic meningoencephalitis and a history of frequent visits to the Montenegrin seacoast, was admitted to the CCS with fever, pancytopenia and moderate hepatosplenomegaly. A stained BMS revealed abundant Leishmania amastigotes. Indirect haemagglutination analysis was positive with a titre of 1 : 2048, and a rapid dipstick rK39 test was also positive. Treatment by liposomal amphotericin B was successful; however, shortly after, the patient developed neural infection and pneumonia and died. The causative agent was identified as L. infantum ., Conclusion: Molecular diagnosis of VL and species delineation using DNA from unstained BMSs stored for several years is possible.

Introduction: Human dirofilariasis is a zoonotic disease caused by Dirofilaria repens and Dirofilaria immitis. It usually presents as a nodular lesion in the lung, subcutaneous tissues or eyes. In animals, dirofilariasis is a very common disease with serious cardiovascular and respiratory manifestations. If adequate therapy is not given at the beginning ofthe disease, dirofilariasis can lead to animal death. On the contrary, human dirofilariasis is frequently mild, sporadic and asymptomatic disease. Complications in humans are very rare. In Europe, human dirofilariasis is a very rare zoonotic disease even in endemic areas such as Italy, Spain and the Mediterranean., Case Report: The authors reported the case of a 43-year-old male with a subcutaneous nodule caused by Dirofilaria repens. The patient who lives in Budva, Montenegro, had a nodule in the right-hand side of the anterior abdominal walljust below the sternum with maximum diameter of 3 cm. His health condition was good and all laboratory analyses were normal. The lesion was surgically removed and the histopathological examination confirmed the parasitic infection by Dirofilaria repens. After surgical excision, the patient was treated with dual antimicrobial therapy (100 mg doxycycline per os twice a day for 28 days and 200 mg albendazole per os twice a day for 10 days)., Conclusion: It is very difficult to make the diagnosis of a subcutaneous nodule. The difficulties arise in the differential diagnosis because subcutaneous nodules are suspected to be malignant neoplasm or other pathologies such as tuberculosis, fungal infections, sebaceous cysts, hamartomas, abscesses, and so on. Although human dirofilariasis is a rare disease, the number of reported cases has recently been increasing worldwide.

Background: Delirium is an urgent condition in psychiatry and it occurs after long-lasting alcohol abuse, in surgical procedures and other organic mental syndromes with deprivation of interpersonal and social stimulations. The aim was to evaluate of sociodemographical and psychopathological differences in delirium patients with alcoholand surgical genesis, studied in period from January 1(st) 2003 to December 31(st) 2012 in Bosnia and Herzegovina (B&H)., Subjects and Methods: Subjects were divided into two groups: alcoholics (N=75) and surgical patients (N=75) and multicentric, prospective study was performed in B&H. The following instruments have been used: list of general data (according to MCD-10 criteria), Eysenck Personality Questionnaire (EPQ), Becks test of anxiety (BAI), Hamilton Depressive Rating Scale (HDRS) and Mini Mental State Examination (MMSE). Descriptive and analytical statistical processing of patients has been performed (alpha level: 0.001)., Results: Patients from alcohol group showed, with statistical significance p=0.001, the following: unemployment (OR=0.657, CI 0.540-670), ruined marriage (OR=0.570, CI 0.650-710), alcohol abuse (OR=0.179, CI 0.860-0.990), on represented expressed psychoticism, (OR=0.635, CI 0.550-0.715) in EPQ test, HDRS total was more frequent (OR=0.925, CI 0.870-1.120) and on MMSE test, total score was more frequent (OR=0.560, CI 0.570-810). Postoperative patients were older p=0.001 (OR=1.120, CI 1.082-1.159) with acutestress: (OR=0.735, CI 0.650-0.910) and showed neuroticism (OR=-0.660, CI 0.575-0.715). Discriminative function confirms the differences between alcohol and surgical groups of delirium patients: Canonical Fcn: r=0.771; Wilkin's lambda (λnj)=0.773 Student's test=57.551 and significance p=0.001; OR=0.760, CI 0.550-0.870., Conclusion: Delirium lasts longer in alcohol group with higher disalienation, depression of cognitive functions with organic lesions of cerebral functions. In surgical patients, delirium is the consequence of older age, acute stress, multi-morbidity, with neuroticism, vegetative disorders (HDRS) and temporary lesion on MMSE test. Delirium state in both groups requires intensive care and multidisciplinary work.

Objectives: The goal of this study was to assess the clinical significance of conventional and PCR-based molecular diagnosis in patients with imported malaria in Serbia., Methods: Giemsa microscopy, the rapid diagnostic test, and quantitative real-time PCR (qPCR) were used to detect Plasmodium species in 109 whole-blood samples from patients after their return from malaria endemic areas, including those clinically suspected for malaria (n=97) and healthy travelers (n=12) examined as part of epidemiological surveillance., Results: A total of 45 patients were diagnosed with malaria: 42 (93.3%) by microscopy and three (6.7%) additional ones by qPCR. The agreement between the results of species-specific qPCR and microscopy was 73.3%; it was as high as 90.6% for Plasmodium falciparum infections. Follow-up analysis demonstrated persistence of Plasmodium sp DNA for a mean 6 days after the disappearance of parasitemia on microscopy., Conclusions: Due to its sensitivity and specificity, qPCR is a helpful method complementary to microscopy, particularly in cases of low parasitemia. In addition, it is superior to microscopy for species identification., (Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: Destructiveness in aggressive behavior is interpreted as having many causes, the psychiatric ones being of biological, social and psychopathological nature. This study was aimed at examining the differences among the perpetrators who have committed crimes and misdemeanors in Bosnia and Herzegovina in the period from January 1st, 2003 to December 31st, 2012., Material and Methods: This prospective, multicentric study used the following measuring instruments: list of general data. Hamilton Rating Scale, the Emotional Profile Index with descriptive and multivariate statistical analysis., Results: Multivariate regression analysis showed that the following variables were significantly associated with violence P=0.001: long treatments OR= 810 (95), CI 0.770 -1.110], migrations [OR=0.830 (95%), CI = 0.825 -1.125,], depression [OR=1.150 (95%); CI=0.790-0.990] and the destructiveness revealed by the Emotional Profile Index test. Misdemeanors were significantly related with the following variables: P =0.001: father's education [OR=0.910 (95%), CI=0.620-1.100]; living in a suburb [OR=0.850 (95%), CI = 0.930 -1.25, P<0.001], destructiveness [OR= 0.670 (95%), CI= 990-1.210, P<0.001]; incorporation and bias on Emotional Profile Index test., Conclusion: This study has confirmed the increase of destructiveness in aggressive behavior in Bosnia and Herzegovina, which is of great medical and legal significance. The study points to the social and psychopathological characteristics of aggression in Bosnia and Herzegovina.

Introduction: Cryptosporidiosis is an acute infectious parasitic disease of the gastrointestinal tract, considered as zoonosis underestimated in immunocompetent population. The pathogen is primarily the cause of devastating diarrhea in AIDS patients. Solitary cases and small outbreaks in immunocompetent persons are rarely discovered. There is also a human strain of cryptosporidium., Case Outline: In December 2010, we examined three family members among whom each successively developed acute gastroenteritis. Their stools were liquid, light brown, without mucus or blood. All of them had abdominal cramps and generalized muscle pains. The daughter had fever and vomited during the first two days. The patients were administered symptomatic therapy. Complaints resolved after 10-17 days, with general condition moderately changed. Cryptosporidium was confirmed in the stool of patients who were second and third to contract the disease. We presumed that the first person released pathogen before the time of examination, although she still had diarrhea. All of them recovered completely. By epidemiologic survey we were unable to presume with certainty the source of infection., Conclusion: This is the first description of cryptosporidiosis in immunocompetent individuals in Serbia, which proves that it is present in our country, and that search for it should be included into a routine parasitological check-up of stool. Taking into account the distance in onset time complaints, all combinations are possible; from infection among family members (shortest incubation period) to family members infected from an identical source (different incubation period). Negative finding of the sample collected on the 7th day from the beginning of symptoms does not exclude the diagnosis in this particular situation. Further epidemiologic studies of this disease are necessary as it is clear that it exists in our population. At that moment we were unable to do typization.

Since 2000, travel of Serbian citizens to tropical areas has been slowly but steadily increasing. To determine the epidemiological and clinical characteristics of imported malaria in Serbia, we analyzed clinical history data of all travelers who presented at the Clinic for Infectious and Tropical Diseases in Belgrade after their return from tropical and subtropical areas between 2001 and 2009. The study series involved a total of 2981 travelers, and included both those with (847) and without (2134) health problems. Malaria was diagnosed in 102 cases (3.4% of all travelers; 12.0% of travelers with febrile episodes). Occurring at a rate of 6 to 16 cases per year, it was predominantly imported from Africa (92.2%), particularly from Equatorial Guinea (38.2%) and Nigeria (15.7%). The most frequent reason for travel was work/business. Patients were predominantly (87.3%) male, and the majority (66.7%) was between 40 and 59 years of age. A total of 15 (14.7%) patients took some form of anti-malarial chemoprophylaxis. The dominant causative species was Plasmodium falciparum (78), alone (70) or in mixed infection with P. vivax (5) and P. malariae (3). P. vivax, P. ovale and P. malariae as single agents were each identified in 11, 1 and 1 cases, respectively. Of the 11 cases in which the parasite was not detected, six appeared to be true submicroscopic cases. The clinical course of the disease was severe in 13 patients, all with falciparum malaria, of which three (2.9%) died. Rather than for all travelers, in Serbia screening for malaria should be mandatory in all travelers to endemic regions who present with fever irrespective of chemoprophylaxis history. Inadequate sensitivity of conventional diagnostic methods, illustrated by the cases of submicroscopic malaria, requires introduction of molecular diagnosis in routine practice.