Background Human brucellosis remains endemic in Bosnia and Herzegovina (B&H), yet integrative studies explaining transmission patterns, population structure, and susceptibility profiles in an endemic setting are lacking. This study aimed to characterise human Brucella melitensis (B. melitensis) isolates from B&H using a combined epidemiological, phenotypic, and genomic approach. Methods A total of 60 B. melitensis blood isolates obtained from patients with confirmed brucellosis between 2015 and 2021 were selected from a multicentre collection for phenotypic antimicrobial susceptibility testing (AST) and whole-genome sequencing (WGS). Broth microdilution (BMD) in three different broth media was used and interpreted according to the Clinical and Laboratory Standards Institute (CLSI) and European Committee on Antimicrobial Susceptibility Testing (EUCAST) criteria. Genomic analyses included phylogenomic contextualisation using publicly available genomes, and screening for acquired antimicrobial resistance determinants and virulence-associated genes. Results Human brucellosis predominantly affected working-age males and was strongly associated with occupational and household exposure. While phenotypic AST showed that first-line antimicrobials remain effective in vitro, the results were significantly impacted by both the choice of culture media and the interpretive framework, with major discrepancies observed between CLSI and EUCAST classification, particularly for streptomycin and trimethoprim–sulfamethoxazole. WGS revealed a high degree of clustered genomic homogeneity within the East Mediterranean lineage. No acquired antimicrobial resistance (AMR) genes were detected, while a conserved virulence gene repertoire was observed across isolates, including genes associated with membrane adaptation such as mprF. Conclusions Human brucellosis in B&H is characterised by sustained endemic transmission within a genetically conserved B. melitensis population. Integration of epidemiological, phenotypic AST, and genomic data highlights the importance of interpreting susceptibility patterns in the light of Brucella’s slow evolutionary dynamics and local epidemiological context. The genomic baseline established in this study supports future One Health surveillance integrating human and animal reservoirs.

Hantaviruses are not emerging pathogens in the strict sense, but their public health relevance is being reshaped by climate change, environmental disruption, land-use change, and increasing human mobility. In Southeast Europe, where Dobrava-Belgrade virus and Puumala virus remain endemic, these infections should no longer be viewed only as sporadic rodent-borne diseases of rural or forested environments. Changing ecological conditions can alter reservoir abundance, virus circulation, and human exposure, while fragmented surveillance and variable diagnostic capacity may obscure the true burden of disease. Although human infection is still driven primarily by environmental exposure to infected rodent excreta, rare person-to-person transmission of Andes virus and recent travel-associated clusters illustrate how traditionally localized zoonoses can acquire wider international relevance. This Opinion argues that hantaviruses should be approached as a climate-sensitive One Health challenge, requiring closer integration of human, veterinary, ecological, and meteorological surveillance. Strengthening regional preparedness is essential before environmental change further expands the conditions for transmission.

Human-pathogenic orthohantaviruses are significant rodent-borne zoonotic pathogens in Europe. Southeastern Europe (SEE) is a distinct endemic region where Dobrava-Belgrade virus (DOBV) and Puumala virus (PUUV) co-circulate, causing hemorrhagic fever with renal syndrome (HFRS) of varying severity. This narrative review synthesizes the epidemiology, transmission dynamics, clinical characteristics, ecological drivers, and public health challenges of hantavirus infections across SEE, identifying priorities for regional preparedness. We searched PubMed, Scopus, and Web of Science from their inception through June 2026, supplementing with reference screening. Regional epidemiological patterns were assessed descriptively using national surveillance data, European surveillance reports, published studies, and available population-based incidence estimates. Long-term surveillance reveals persistent endemic transmission with significant geographic and interannual heterogeneity. Slovenia and Croatia exhibit the highest cumulative burden and most pronounced periods of increased HFRS activity. Several years-2008, 2012, 2014, 2017, 2019, 2021, and 2023-showed partially synchronized increases across multiple neighboring countries. These patterns align with shared ecological influences, including rodent population fluctuations, mast-seeding events, and climatic variability. However, local ecology, human exposure, and differences in surveillance capacity modify their magnitude. The coexistence of generally milder PUUV-associated disease and more severe DOBV-associated HFRS further distinguishes SEE's clinical landscape. Therefore, hantavirus epidemiology in SEE is best understood as an interconnected regional ecological system. Integrated human, animal, environmental, and genomic surveillance within a coordinated One Health framework is crucial for improving outbreak prediction, cross-border preparedness, and future disease control.

Objectives Viral hepatitis presents a significant public health challenge due to its slow progression leading to severe liver disease and death. The aim of this research is to identify risk behaviors and groups associated with hepatitis C, with the goal of directing prevention measures, increasing mass testing, and potentially facilitating treatment in Bosnia and Herzegovina. Methods A case-control study was conducted from 2017 to 2022, involving 69 anti-HCV-positive and 70 control respondents matched for gender and age. After obtaining of informed consent, respondents completed a questionnaire focusing on sociodemographic status and potential risk factors for HCV-infection. Molecular quantification tests were carried out, and genotyping was performed for respondents positive for HCV RNA. Results In this study, we found statistically significantly that anti-HCV respondents are more frequently male, of younger age, with lower educational levels, unemployed, and often unmarried, predominantly residing in urban areas. Behaviors such as tattooing, piercing, contact with others' blood, drug usage, intimate relationships with hepatitis B or C positive partners and having more than two sexual partners in the last 12 months were statistically significantly more common among anti-HCV-positive individuals compared to the control group. However, binary logistic regression analysis identified drug usage as significant risk factor for HCV-infection. Conclusion Due to the fact that the numbers of drug users are continuously increasing among people of younger age, it is very important to direct prevention measures towards this population.

INTRODUCTION:Cytomegalovirus (CMV) seroprevalence varies globally. This study aimed to detect CMV seroprevalence and reactivation among patients who had been exposed to hepatitis B virus (HBV) or hepatitis C virus (HCV). METHODOLOGY:The study was conducted between 2017 and 2022 and included adult participants who were serologically diagnosed with hepatitis B (63 participants) or hepatitis C (69 participants), as well as 132 control respondents. CMV IgG and IgM levels were measured for all 264 respondents; CMV IgG avidity was further determined for those who tested positive for CMV IgG and IgM. RESULTS:The total CMV IgG seroprevalence observed in the study was 95.4%, with 98.5% in HCV-positive, 96.8% in HBV-positive, and 95.2% in control respondents; and with a slightly higher prevalence in women (97.1%) compared to men (94.9%). The overall CMV reactivation rate among anti-HCV positive respondents was 2.9%. Although no significant difference was found in the reactivation rate of CMV between anti-HCV positive and negative respondents, the reactivation rate of CMV within the subgroup of HCV RNA positive individuals was higher at 4.4%. In contrast, no CMV reactivation was observed in the respondents without detectable HCV RNA. No CMV reactivation was detected in the HBV group. CONCLUSIONS:This study did not confirm a higher reactivation rate of CMV in HBV- or HCV-positive respondents compared to the control cases. Given the high CMV seroprevalence among adults in Bosnia and Herzegovina, future research should include CMV DNA testing for more accurate assessment.

Herein, we aimed to analyze the final diagnosis in a well-defined cohort of fever of unknown origin (FUO) cases whose erythrocyte sedimentation rate (ESR) was 100 mm/h or more during the admission. The subgroup of the FUO patients with an ESR of 100 mm/h or more during the FUO evaluation, was extracted from the study database of a previously published multicenter study (European Journal of Clinical Microbiology & Infectious Diseases. April 15, 2023;42 (4):387–98). Data for 139 patients (17.6%, 139/788 of the original cohort) who fulfilled the study inclusion criteria, were obtained from 29 centers from 11 countries. Infections, neoplasms, and noninfectious inflammatory diseases were found to be the reason of fever in [n = 74 (53.2%)], [n = 14 (10%)], and [n = 13 (9.3%)] of 139 patients, respectively. Regardless of the diseases subgroup top 6 diseases that were determined to be the reasons of FUO were tuberculosis [n = 15 (10.8%)], HIV/AIDS [n = 13 (9.3%)], urinary tract infection [n = 9 (6.5%)], infective endocarditis [n = 9 (6.5%)], lymphoma [n = 9 (6.5%)], and abscess [n = 9 (6.5%)]. The most common infectious diseases were tuberculosis (15/74, 20.2%), HIV/AIDS (13/74, 17.5%), and infective endocarditis (9/74, 12.1%), along with urinary tract infection [n = 9 (6.5%)] and abscess [n = 9 (6.5%)]. The most common noninfectious inflammatory diseases were adult onset Still disease (3/13, 23%) and giant cell arteritis, also known as temporal arteritis (3/13, 23%), and followed by polyarteritis nodosa (2/13, 15.3%). The most common neoplasm was lymphoma (9/14, 64.2%), followed by lung cancer (2/14, 14.2%). Reason of fever could not be defined in (29/139, 20.8%) patients. The invasive procedures were performed in (64/139, 46%) patients. Gender, age > 50 or not, and income level (high–middle–low) of the participating country were not associated with a significant difference in the final diagnosis category of the FUO case ( P > .05). To the best of our knowledge, this is the first study evaluating the FUO in the subgroup of cases with extreme ESR elevation and infectious diseases comprised the most cause of the FUO in this particular subgroup.

Background/Objectives: Hepatitis B virus (HBV) remains a persistent challenge for transfusion safety. Although testing for hepatitis B surface antigen (HBsAg) and nucleic acid testing (NAT) reduces transmission risk, antibodies to hepatitis B core antigen (anti-HBc) and antibodies to hepatitis B surface antigen (anti-HBs) provide additional insight into past infection and vaccine-induced immunity. We aimed to determine their seroprevalence among blood donors in southern Croatia and assess associations with age, occupation, and time since vaccination. Methods: This cross-sectional study was conducted between February and November 2024 at two regional transfusion centers in southern Croatia. A total of 1008 voluntary blood donors, all HBsAg- and NAT-negative, were tested for anti-HBc and anti-HBs using chemiluminescent microparticle immunoassay. Demographic and vaccination data were collected through verified medical records. Results: Anti-HBc was detected in 0.5% of donors, exclusively among the unvaccinated. Protective anti-HBs levels were found in 38.1% overall and 70.6% of vaccinated donors, with significant declines by age and more than 15 years post-vaccination (p = 0.024). Healthcare workers showed higher seroprotection than non-healthcare donors (67.0% vs. 35.1%; p < 0.001), although one-third still lacked protective levels. Conclusions: HBV exposure was rare, but waning vaccine-induced immunity was evident, with protective anti-HBs levels in 70.6% of vaccinated donors, declining with age and time since vaccination. These findings highlight the need for periodic monitoring of anti-HBs and targeted booster strategies, especially in older and occupationally exposed groups. HBsAg and NAT provide a high level of transfusion safety, while the role of routine anti-HBc testing in this low-endemic context should be carefully evaluated in view of its potential benefits and drawbacks. Donor-based surveillance is a valuable tool for evaluating long-term vaccine effectiveness and guiding public health policy.

Znanstvena kultura obuhvaća niz pisanih i nepisanih pravila, vrijednosti, praksi i običaja koji predstavljaju način rada i ponašanje znanstvene zajednice. Stoga je uobičajeno da ona oblikuje ponašanje znanstvenika i kvalitetu njegovog rada kroz promicanje integriteta, kolegijalnosti, transparentnosti, otvorenosti i kritičkog promišljanja. Sve to rezultira u društvenoj odgovornosti svakog znanstvenika te pomaže zajednici u rješavanju određenih izazova i problema uz unaprjeđenje zdravlja i kvalitete života. Ne umanjujući značaj ostalih područja znanosti, istraživanja u biomedicini prožeta su visokim standardom poštivanja etičkih načela, kao i svih drugih aspekata znanstvene kulture, što nazivamo znanstvenom čestitošću. Bosna i Hercegovina je na globalnoj mapi među zemljama u razvoju i svakako da se nalazi pred izazovima u raznim sociološkim i znanstvenoistraživačkim aspektima. Takvi izazovi zahtijevaju prije svega visoki stupanj kompetentnosti u bilo kojoj znanstvenoistraživačkoj djelatnosti, a napose u biomedicini. Tijekom pandemije COVID-19 bili smo svjedoci kako je naša znanstvena zajednica u ključnim trenucima upravljala takvom krizom, noseći se s mnogobrojnim teškim izazovima. Uzimajući sve u obzir, postavlja se pitanje može li se znanstvena kultura i integritet znanstvene zajednice u biomedicini još više oplemeniti jačanjem znanstvene čestitosti i kritičnim promišljanjem kroz institucionalni rad kako državnih tako i visokoškolskih ustanova. U ovom radu će se istaknuti neki od ključnih problema u znanstvenoistraživačkoj biomedicinskoj djelatnosti koji mogu negativno utjecati na bosanskohercegovačku znanstvenu kulturu u cijelosti. Osim toga, ukazat će se na moguća rješenja takvih problema, kako bismo kao društvo u cjelini bili napredniji i zadovoljniji unatoč izazovima koje nameću suvremeni civilizacijski dosezi.

Introduction: Hepatitis B is liver inflammation caused by the hepatitis B virus, with more than 250 million documented cases worldwide in the chronic form of infection. Markers of hepatitis B infection can be measured in the blood during or after infection and may be present in the form of specific hepatitis B surface antigen (HBsAg) or antibodies to hepatitis B surface (HBs), core (HBc), or envelope (HBe) antigens. Case report: A 42-year-old female, who successfully donated blood for the first time, underwent mandatory serological and molecular testing along with additional testing for other hepatitis B markers. Standard screening showed the absence of HBsAg in the blood, but additional serological testing confirmed the presence of total antibody to hepatitis B core antigen (anti-HBc). Upon repeated reactive results, the sample was sent for confirmatory testing to a reference center. After obtaining all the results, it was determined that the voluntary blood donor had the presence of anti-HB cand HBs antibodies, indicating a prior contact with the hepatitis B virus. While serological tests suggested a resolved hepatitis B infection, the possibility of a persistent liver infection could not be ruled out, despite the absence of detectable hepatitis B virus DNA in the blood. Therefore, the individual has been permanently excluded from the list of potential blood donors. Conclusion: Mandatory serological and molecular testing of blood donors for the hepatitis B virus successfully detects potentially infected individuals and carriers of hepatitis B markers. However, additional testing further enhances the safety of both recipients and blood donors. This case study highlights the importance of comprehensive screening for hepatitis B markers, as relying solely on HBsAg screening would not have identified the voluntary blood donor as a resolved hepatitis B case. Thus, comprehensive screening ensures a higher level of safety in blood transfusion and contributes to overall healthcare protection.

Amid the global challenges posed by the COVID-19 pandemic, unraveling the genomic intricacies of SARS-CoV-2 became crucial. This study explores viral evolution using an innovative high-throughput next-generation sequencing (NGS) approach. By taking advantage of nasal swab and mouthwash samples from patients who tested positive for COVID-19 across different geographical regions during sequential infection waves, our study applied a targeted enrichment protocol and pooling strategy to increase detection sensitivity. The approach was extremely efficient, yielding a large number of reads and mutations distributed across 10 distinct viral gene regions. Notably, the genes Envelope, Nucleocapsid, and Open Reading Frame 8 had the highest number of unique mutations per 1000 nucleotides, with both spike and Nucleocapsid genes showing evidence for positive selection. Focusing on the spike protein gene, crucial in virus replication and immunogenicity, our findings show a dynamic SARS-CoV-2 evolution, emphasizing the virus–host interplay. Moreover, the pooling strategy facilitated subtle sequence variability detection. Our findings painted a dynamic portrait of SARS-CoV-2 evolution, emphasizing the intricate interplay between the virus and its host populations and accentuating the importance of continuous genomic surveillance to understand viral dynamics. As SARS-CoV-2 continues to evolve, this approach proves to be a powerful, versatile, fast, and cost-efficient screening tool for unraveling emerging variants, fostering understanding of the virus’s genetic landscape.

This study explores the correlation between immunological and clinical characteristics in coronavirus disease 2019 (COVID-19) patients with detectable severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA in feces, analyzing data from 251 patients admitted to Mostar University Clinical Hospital (UCH) from December 2021 to January 2022. Methods involved reverse transcription quantitative polymerase chain reaction (RT-qPCR) from nasopharyngeal (NP) swabs and feces, alongside serological tests for anti-SARS-CoV-2 spike IgGs. Demographic and clinical data were collected through questionnaires and medical records. The data analyses were performed using SPSS statistical software. Death occurred in 53 patients (21.1%, P < 0.001), mostly in the elderly (47/53, 88.7%, P = 0.001) and immunocompromised (19/53, 35.8%, P = 0.05), particularly those developing acute respiratory insufficiency (ARI) (46/53, 86.8%, P = 0.004), and severe/critical disease (46/53, 86.8%, P = 0.002). Among the patients with positive anti-SARS-CoV-2 IgG antibodies (86/251, 34.3%, P < 0.001), 41 (47.7%) were vaccinated and 45 (52.3%) unvaccinated (P = 0.666), showing no significant differences in clinical outcomes or mortality. Unvaccinated patients with a negative antibody titer had a higher incidence of ARI (96/123, 78%, P = 0.029) and intensive care unit (ICU) admission (22/123, 17.9%, P = 0.026), than those with a positive antibody titer. Forty-seven (62.7%) patients, out of the 75 hospitalized who provided a feces sample, were positive for SARS-CoV-2 RNA (P = 0.028), without statistical differences between fecal SARS-CoV-2 positive and negative groups regarding vaccination status (15/47, 31.9%, P = 0.493), antibody status (18/47, 38.3%, P = 0.628), or death outcome (5/47, 10.6%, P = 0.706). In conclusion, unvaccinated hospitalized patients with a severe COVID-19 presentation and a negative anti-spike SARS-CoV-2 IgG titer had adverse outcomes more frequently. This suggests cautious consideration for the diagnostic use of fecal samples compared to NP swabs.

Objective: This study explores the adverse effects to different messenger RNA (mRNA) vaccines (BNT162b2/Pfizer or mRNA-1273/Moderna) in health-care workers (HCWs) who received a third (booster) dose and were previously vaccinated twice with the adenoviral vector vaccine (ChAdOx1-S/Astra Zeneca). Materials and methods: The data were collected based on surveys of 175 HCWs at the University Clinical Hospital (UCH) Mostar from October 2021 to March 2022. The participants filled out the initial general survey form immediately before the booster vaccination and a second survey form regarding adverse effects after the vaccination. Based on the administered vaccines, HCWs were divided into two groups – Pfizer and Moderna. Data organisation and statistical analysis were performed using Microsoft Excel and SPSS statistical software. Results: Out of 175 participants, 132 (75.4%) had mild adverse effects post-vaccination, while no severe adverse effects were recorded. Adverse effects overall were significantly more frequent in participants vaccinated with the Moderna vaccine compared to the Pfizer vaccine (82.7%, P < 0.001) and were significantly more prevalent in women (82.5%, P = 0.031). Specifically, shoulder pain, chills, shivering, and fever were more frequently reported by participants vaccinated with the Moderna vaccine. Conclusions: Both mRNA vaccines were considered safe to use, while the use of the Pfizer vaccine as a booster dose in a heterologous vaccination approach might have a lower incidence of adverse effects. Thus, the wide range of available vaccines is favourable during pandemic, and their dosages should be reconsidered primarily according to their immunological effectiveness in the future. Keywords: COVID-19, COVID 19 Vaccines, booster vaccination, adverse effects, health-care workers.

Bolest uzrokovana SARS-CoV-2 (COVID-19) izrazito je zarazna bolest, koja zadnje tri godine ima izuzetno loš utjecaj na svjetsku demografiju, rezultirajući s gotovo 6,5 milijuna umrlih diljem svijeta. U ovom trenutku još uvijek ne postoji učinkoviti ciljani lijek, a liječenje određuje težina bolesti. Terapija remdesivirom pokazala je određeno kliničko poboljšanje, zbog čega ga je Food and Drug Administration odobrio kao prvi ispitivani lijek u liječenju COVID-19. Ovo retrospektvno opservacijsko istraživanje uključilo je bolesnike liječene remdesivirom u Općoj bolnici Zadar u razdoblju od 1. kolovoza 2020. do 1. kolovoza 2021. godine. Primarni cilj bio je utvrditi komorbiditete i klinički ishod bolesnika liječenih remdesivirom. Najčešće kronične bolesti bile su arterijska hipertenzija (80; 58,4%), dijabetes (44; 32,1%) i maligne bolesti (14; 10,2%). Ukupno je 86 bolesnika (62,7%) pripadalo skupinama teško i kritično bolesnih, a preostalih 51 (37,2%) bili su umjereno bolesni. Smrtnost je bila značajno veća u skupini teško bolesnih i iznosila je 23,4%, dok je u skupini umjereno bolesnih bila 5, 9% ( p=0,0287).

In veterinary medicine, the relationship between empathy and mental health presents a complex and important aspect of professional well-being. Veterinarians are frequently exposed to numerous work-related stressors and are therefore more likely to experience mental health disorders and commit suicide. Due to the specific nature of the profession, veterinarians deal with negative patient outcomes, inform owners of unfavourable news, handle heavy workloads, and professional isolation. Psychological stress is a result of all these factors coming together, and it can lead to anxiety, depression, burnout, and even frequently reported suicide. Animal euthanasia has been recognised as a unique professional risk factor that can have harmful psychological effects on veterinary professionals. This paper explores the role of empathy in the mental health of veterinarians and other veterinary staff, and how this might contribute to their vulnerability to psychological stress and suicidal ideation. Empathy plays an important role in interpersonal interactions, while also influencing human-animal relationships, which adds a whole new level of complexity to the doctor-patient dynamic in this field. Veterinarians are responsible for providing compassionate care for both the animals they treat and their owners. They must manage the emotionally demanding work while preserving their mental health by balancing between providing empathetic care and sustaining their own emotional boundaries. To alleviate the negative effects of psychological stress, veterinary professionals require interventions such as peer support groups, stress management training, and mental health support programmes.

Background: Kpa occurs in less than 2 percent of the Caucasian population. Antibody to this low frequency antigen causes mild to moderate delayed hemolytic transfusion reactions and hemolytic disease of fetus and newborn. Screening for antibodies to low frequency antigens such as Kpa is not routine, so sensitization is more difficult to diagnose. Case report: We present a case of hemolytic disease of the newborn due to anti-Kpa antibody unrecognised during regular considered first pregnancy. Results: Newborn, blood group 0 RhD positive, has been diagnosed with neonatal jaundice and positive direct antiglobuline test. Mother's screening test for irregular antibodies was negative three times during pregnancy. Elution was negative with screening red blood cells, but in identification using gel technology with cell's panels, anti-Kpa has been identified. Conclusion: Screening for antibodies to low frequency antigens such as Kpa is not routine, so immunisation to low incidence antigens is hard to diagnose, but very important. This case should alert us that there really is potential of antibodies to low incidence antigens to cause severe reactions. Keywords: Kell blood group system; Hemolytic disease of newborn; red cell alloimmunisation

Objectives: The aim of this research was to determine the seroprevalence of Toxoplasma gondii in Bosnia and Herzegovina, with special reference to women of reproductive age in Bosnia and Herzegovina.Methods: The retrospective cross-sectional study included 3685 participants tested at the Department of Microbiology and Molecular Diagnostics, University Clinical Hospital, Mostar in the period from January 1, 2010 to December 31, 2019. The detection of IgG and IgM antibodies to T. gondii was based on the enzyme immunofluorescence test.Results: In this study the total IgG prevalence of T. gondii was 18.7%, while only 1.7% were IgM positive. The IgG prevalence increased according to age of participants from 1.8% in 1-5 age group to 46.8% in participants older than 65 (p < 0.001). Out of total IgG positive participants, 62.8% came from rural areas (p < 0.001). An increased age (OR = 2.233) and rural residence (OR = 1.468) were found as risk factors for toxoplasmosis, whereas gender was not (OR =1.021). Out of total 1514 women of reproductive age tested, the IgG prevalence of T. gondii was 15.8%, and IgM antibodies was present in 1.6% examined women.Conclusions: This study showed a seroprevalence of T. gondii in Bosnia and Herzegovina, not only among the general population, but also among women of reproductive age. Results of the study suggest the need for more systematic preventive monitoring of pregnant women and preconception counselling for women of reproductive age.

Fever of unknown origin (FUO) is a serious challenge for physicians. The aim of the present study was to consider epidemiology and dynamics of FUO in countries with different economic development. The data of FUO patients hospitalized/followed between 1st July 2016 and 1st July 2021 were collected retrospectively and submitted from referral centers in 21 countries through ID-IRI clinical research platform. The countries were categorized into developing (low-income (LI) and lower middle-income (LMI) economies) and developed countries (upper middle-income (UMI) and high-income (HI) economies). This research included 788 patients. FUO diagnoses were as follows: infections (51.6%; n = 407), neoplasms (11.4%, n = 90), collagen vascular disorders (9.3%, n = 73), undiagnosed (20.1%, n = 158), miscellaneous diseases (7.7%, n = 60). The most common infections were tuberculosis (n = 45, 5.7%), brucellosis (n = 39, 4.9%), rickettsiosis (n = 23, 2.9%), HIV infection (n = 20, 2.5%), and typhoid fever (n = 13, 1.6%). Cardiovascular infections (n = 56, 7.1%) were the most common infectious syndromes. Only collagen vascular disorders were reported significantly more from developed countries (RR = 2.00, 95% CI: 1.19-3.38). FUO had similar characteristics in LI/LMI and UMI/HI countries including the portion of undiagnosed cases (OR, 95% CI; 0.87 (0.65-1.15)), death attributed to FUO (RR = 0.87, 95% CI: 0.65-1.15, p-value = 0.3355), and the mean duration until diagnosis (p = 0.9663). Various aspects of FUO cannot be determined by the economic development solely. Other development indices can be considered in future analyses. Physicians in different countries should be equally prepared for FUO patients.

Objectives: Non-tuberculous mycobacteria are opportunistic pathogens that cause disease mainly in im-munocompromised hosts. The present study assessed the prevalence of antibiotic resistance among such mycobacteria from domestic and wild animals in Croatia sampled during several years within a national surveillance program.Methods: A total of 44 isolates belonging to nine slow-growing species were genotyped and analyzed for susceptibility to 13 antimicrobials often used to treat non-tuberculous mycobacterial infections in humans.Results: Most prevalent resistance was to moxifloxacin (77.3%), doxycycline (76.9%), and rifampicin (76.9%), followed by ciprofloxacin (65.4%), trimethoprim-sulfamethoxazole (65.4%), and linezolid (61.4%). Few isolates were resistant to rifabutin (7.7%) or amikacin (6.8%). None of the isolates was resistant to clarithromycin. Nearly all isolates (86.4%) were resistant to multiple antibiotics.Conclusion: Our findings suggest substantial risk that human populations may experience zoonotic in-fections with non-tuberculous mycobacteria that will be difficult to treat using the current generation of antibiotics. Future work should clarify how resistance emerges in wild populations of non-tuberculous mycobacteria.& COPY; 2023 The Author(s). Published by Elsevier Ltd on behalf of International Society for Antimicrobial Chemotherapy.This is an open access article under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ )