<p>Uvod: Virusni gastrointestinalni sindrom je aktuelni zdravstveni problem u celom svetu. To važi kako u razvijenim zemljama, tako i u zemljama u razvoju, a posebno u nerazvijenim zemljama, gde je drugi po redu uzrok mortaliteta. Nagli početak bolesti, praćen pojavom velikog broja tečnih stolica, mukom, povraćanjem, bolovima u stomaku, temperaturom, malaksalo&scaron;ću, ima za posledicu dehidrataciju. U svim starosnim grupama obolelih, a naročito kod sasvim male dece, starih i imunodeficitarnih osoba može da dođe do smrtnog ishoda, ukoliko se brzo ne postavi tačna etiolo&scaron;ka dijagnoza bolesti i ne pristupi se odmah nadoknadi vode i elektrolita, kao i primeni svih ostalih mera simptomatske terapije. Brzo postavljena tačna dijagnoza, &scaron;to se najbolje postiže real-time PCR testom, sprečava pojavu komplikacija, pa i fatalnog ishoda bolesti. Istovremeno, omogućava primenu odgovarajućih epidemiolo&scaron;kih mera da se spreči nastanak epidemija i njihovo &scaron;irenje. Cilj ovog istraživanja bio je da se tačno utvrdi incidenca virusnog gastrointestinalnog sindroma u Vojvodini i učestalost pojave epidemijskog i sporadičnog javljanja ove bolesti. Cilj je bio i postavljanje algoritma za primenu real-time PCR testa u dijagnostici virusnog gastrointestinalnog sindroma u budućem radu. Isto tako, cilj je bio da se molekularnom analizom, sekvenciranjem delova genoma pozitivnih uzoraka stolice, izvr&scaron;i genetska tipizacija i odredi filogenetska pripadnost virusa. Materijal i metode: Tokom petogodi&scaron;njeg istraživanja molekularnim real-time PCR testom pregledane su 1003 obolele osobe sa simptomima virusnog dijarealnog sindroma, starosti od mesec dana do preko 90 godina. Pregledani su na rota, noro, astro i enterične adenoviruse. Na osnovu podataka iz anketnih upitnika i istorija bolesti, detaljno su analizirani svi klinički pokazatelji (javljanje bolesti tokom godine, trajanje bolesti, simptomi). Procena težine kliničke slike vr&scaron;ena je prema Vesikari skali. Svi podaci su upoređivani prema vrsti virusnog uzročnika, prema starosti obolelih, godinama trajanja istraživanja i epidemijskom i sporadičnom javljanju oboljenja. Dobijeni podaci su statistički obrađeni, tabelarno i grafički prikazani. Rezultati: U petogodi&scaron;njem periodu real-time PCR testom pregledan je uzorak od 1003 obolele osobe različite starosti na 4 virusna uzročnika dijarealnog sindroma (rota, noro, astro i enterične adenoviruse). Virusni dijarealni sindrom dokazan je kod 709 obolelih (70,69%). Najče&scaron;će su dokazane rotavirusne infekcije u 28,81%. Statistički značajno najče&scaron;će rotavirusi su bili utvrđeni kod dece do 5 godina (38,90%), ali u visokom procentu i kod dece uzrasta 6 do 14 godina (24,83%). Deca mlađa od 5 godina imala su statistički značajno najtežu kliničku sliku, bila su če&scaron;će hospitalizovana i imala su statistički značajno vi&scaron;u temperaturu. Pored vi&scaron;e temperature kod obolelih od rotavirusa, klinička slika je kod ovih bolesnika bila teža i bolest je duže trajala nego kod obolelih od drugih virusa. Norovirusna infekcija je dokazana u 23,03% obolelih i to statistički značajno če&scaron;će kod odraslih osoba, starijih od 20 godina. Od kliničkih simptoma kod ovih bolesnika statistički značajno če&scaron;će su dokazani muka, povraćanje i bolovi u stomaku, nego kod obolelih od drugih virusa. Norovirusi su značajno če&scaron;će bili uzročnici epidemijskog javljanja bolesti. Astrovirus je dokazan kod znatno manjeg broja obolelih (u 2,29%) i to samo kod dece do 5 godina i dece uzrasta 6 do 14 godina. Infekcija izazvana enteričnim adenovirusima dokazana je kod 13,36% bolesnika. Njače&scaron;će je utvrđena kod dece uzrsta do 5 godina i 6 do 14 godina. Oboleli od adenovirusa imali su statistički značajno blažu kliničku sliku bolesti. Dva virusna uzročnika u uzorku stolice dokazana su u 3,19% osoba, obično u toku epidemijskog javljanja bolesti. Ovi bolesnici su imali bitno težu kliničku sliku. Najvi&scaron;e obolelih od dijarealnog sindroma bilo je u hladnim mesecima, mada su dijagnostikovani i tokom cele godine. U petogodi&scaron;njem periodu utvrđene su 22 epidemije u kolektivima i 9 porodičnih epidemija. Epidemijsko javljanje bolesti bilo je statistički značajno najče&scaron;će kod najstarijih bolesnika (starijih od 50 godina), a sporadično javljanje bilo je statističko značajno najče&scaron;će kod dece. U cilju potvrde tačnosti dijagnostike virusa u ispitivanim uzorcima real-time PCR testom, genotipizacije, kao i detaljnije molekularne analize, izabrani su reprezentativni uzorci pozitivni na rota, noro, astro ili adenoviruse. Delovi genoma ovih uzoraka su amplifikovani, a zatim sekvencirani. Sekvencirani izolati rotavirusa pripadali su grupi A i tipovima G1P[8], G2P[4], G3P[8] i G9P[8]. Sekvencirani izolati norovirusa pripadali su genogrupi I tipu 2, zatim genogrupi II tipovima 1, 2, 4 i 17. Sekvencirani izolati astrovirusa pripadali su grupi klasičnih astrovirusa i tipovima 1, 4 i 5. Sekvencirani izolati adenovirusa pripadali su grupi F i tipovima 40 i 41, kao i grupi C tipu 2. Pripadnost dobijenih sekvenci u ovom istraživanju, dodatno je potvrđena izradom filogenetskog stabla za sekvence pozitivne na rota, noro, astro ili adenoviruse. Zaključak: Incidenca virusnog dijarealnog sindroma u Vojvodini (70,69%) vrlo je visoka i vi&scaron;a je nego &scaron;to je bilo pretpostavljeno prilikom prijave teze (u hipotezi). Real-time PCR test treba da bude redovno kori&scaron;ćen u budućem dijagnostičkom radu, jer dovodi do brze dijagnostike, čak i ako su virusi prisutni u malom broju u uzorcima tečnih stolica, &scaron;to je utvrđeno tokom ovog dijagnostičkog rada. Ispitivani virusi treba da budu redovno dijagnostikovani kod obolelih od dijarealnog sindroma i to u svim starosnim grupama, tokom epidemijskog i sporadičnog javljanja oboljenja.</p> / <p>Introduction: Viral gastrointestinal syndrome is a current ongoing health problem worldwide. This is true of both developed and developing countries, especially underdeveloped ones where it is the second leading cause of mortality. Sudden onset of the disease&mdash;accompanied by the occurrence of large numbers of liquid stools, nausea, vomiting, abdominal pain, fever, and exhaustion&mdash;leads to dehydration. A fatal outcome can occur in all age groups of patients, especially very young children, the elderly, and the immuno-deficient, unless an accurate etiological diagnosis of the disease is quickly established, followed by a prompt institution of fluid and electrolyte placement, and implementation of other symptomatic therapy measures. Quick establishment of an accurate diagnosis, which is best achieved using the real-time PCR test, prevents the onset of complications, including a potentially fatal outcome of the disease. Simultaneously, it enables the implementation of appropriate epidemiological measures to prevent epidemic outbreaks and their spread. The aim of this study was to accurately determine the incidence of viral gastrointestinal syndrome in Vojvodina and the frequency of epidemic and sporadic occurrence of this disease. The aim was also to set up an algorithm for the application of the real-time PCR test in diagnostics of viral gastrointestinal syndrome in future work. Likewise, the aim was to carry out genetic typing and determine phylogenetic affiliation of the virus using molecular analysis and sequencing of parts of genomes from positive stool samples. Material and Methods: During a five-year study, 1003 patients with symptoms of viral diarrheal syndrome, aged from one month to more than 90 years old, were examined using molecular real-time PCR test. They were screened for rota, noro, astro, and enteric adenoviruses. Based on the data from survey questionnaires and medical case history, all clinical indicators were meticulously analyzed (disease occurrence during the year, disease duration, symptoms). The assessment of the clinical severity was carried out according to the Vesikari Clinical Severity Scoring scale. All data were compared according to the type of the viral causing agent, age of the patients, duration of research in years, and epidemic and sporadic occurrence of the disease. Obtained data were statistically analyzed, tabulated, and graphically displayed. Results: In a five-year period, a sample of 1003 patients of different ages was screened for four different viral causing agents of diarrheal syndrome (rota, noro, astro, and enteric adenoviruses) using the real-time PCR test. Viral diarrheal syndrome was confirmed in 709 patients (70.69%). The most commonly found were rotavirus infections in 28.81% of the cases. Rotaviruses were statistically significantly most common in children younger than 5 years old (38.90%), but were also found in high percentage in children aged 6-14 years old (24.83%). Children under 5 years of age had statistically significantly highest clinical severity and fever, and were more frequently hospitalized. In addition to higher fever in patients with rotavirus, clinical severity in these patients was also higher, and the disease lasted longer than in patients with other viruses. Norovirus infections were reported in 23.03% of the subjects, statistically significantly more frequently in adults over 20 years of age. Regarding the clinical symptoms in these patients, nausea, vomiting, and abdominal pain were statistically significantly more common than in patients with other viruses. Noroviruses were significantly more common as causing agents of epidemic disease outbreaks. Astrovirus was found in a significantly smaller number of patients (in 2.29%), and only in children under 5 years of age and children aged 6-14 years old. Enteric adenovirus infections were reported in 13.36% of the subjects. They were most commonly found in children younger than 5, and those aged 6- 14 years old. Adenovirus sufferers had statistically significantly milder clinical disease. Two viral causing agents in the stool sample were found in 3.19% of the subjects, usually during an epidemic disease outbreak. These patients had a significantly more severe clinical disease. Highest numbers of sufferers from diarrheal syndrome occurred during the cold months, although they were diagnosed throughout the year. In a five-year period, 22epidemics in collective groups and 9 family epidemics were identified. Epidemic outbreaks of the disease were statistically significantly most frequent in the elderly patients (older than 50), while sporadic occurrences were statistically significantly most frequent in children. Representative samples positive for rota, noro, astro, or adenoviruses were selected in order to confirm the accuracy of virus diagnostics in samples tested by the real-time PCR test, and perform genotyping as well as more detailed molecular analyses. Parts of the genomes of these samples were amplified and then sequenced. Sequenced rotavirus isolates belonged to group A and types G1P[8], G2P[4], G3P[8], and G9P[8]. Sequenced norovirus isolates belonged to genogroup I type 2, and genogroup II types 1, 2, 4, and 17. Sequenced astrovirus isolates belonged to the group of classical astroviruses and types 1, 4, and 5. Sequenced adenovirus isolates belonged to group F and types 40 and 41, as well as group C type 2. The affiliation of the obtained sequences in this study was further confirmed by creating a phylogenetic tree for sequences positive for rota, noro, astro, or adenoviruses. Conclusion: The incidence of viral diarrheal syndrome in Vojvodina (70.69%) is very high&mdash;higher than what was assumed at the time of the thesis submission (in the hypothesis). The real-time PCR test should be regularly used in future diagnostic work, since it leads to rapid diagnostics even if viruses are present in small numbers in liquid stool samples, as determined in the course of this diagnostic study. The investigated viruses should be regularly tested in patients with diarrheal syndrome belonging to all age groups during both epidemic and sporadic occurrences of the disease.</p>

<p>Vi&scaron;e od 100 vrsta virusa ljudi i životinja se izlučuje u spolja&scaron;nju sredinu. Prisustvo ovih virusa u povr&scaron;inskim vodama reflektuje fekalnu kontaminaciju i ukazuje na<br />opasnost za zdravlje ljudi i životinja. Na području Srbije se ne prati prisustvo patogenih virusa u povr&scaron;inskim vodama, pa&nbsp; čak ni u vodama za piće, a nije uspostavljena&nbsp; ni&nbsp; metodologija ovih ispitivanja. Shodno tome, cilj disertacije je da se utvrdi i analizira prisustvo animalnih i humanih virusa u povr&scaron;inskim vodama primenom najsavremenijih metoda koncentrovanja i detekcije virusa. U okviru disertacije ispitano je prisustvo sledećih virusa u povr&scaron;inskim vodama na teritoriji Vojvodine: humanih adenovirusa (HAdV); norovirusa (NoV) i hepatitis A virusa (HAV), adenovirusa svinja (PAdV),&nbsp; poliomavirusa goveda (BPyV) i hepatitis E virus (HEV).</p><p>Ispitano je ukupno 108 uzoraka povr&scaron;inskih i otpadnih voda koji su prikupljani od oktobra 2012. godine do juna 2014. godine. U radu su primenjene najsavremenije metode koncentrovanja i detekcije virusa u vodi, koje se u Srbiji nisu koristile za ovu namenu. Sprovedenim ispitivanjima dokazano je da su animalni i humani virusi prisutni u povr&scaron;inskim vodama na području Vojvodine. Najče&scaron;će detektovan&nbsp; virus u povr&scaron;inskim vodama je humani adenovirus (42,4%), a potom norovirusi GII i GI (40,4% i 15,2%), adenovirus svinja (11,1%), poliomavirus goveda (7,1%) i hepatitis E virus (3,0%). U ukupno 9 testiranih uzoraka gradske kanalizacione vode najče&scaron;će je detektovan HAdV (44,4%), NoV GII i GI&nbsp; (66,7% i 22,2%), BPyV je detektovan u samo jednom od 9 uzoraka, a niti u jednom nisu detektovani PAdV i HEV. Hepatitis A virus nije detektovan u uzorcima, a eksperimentalno je potvrđeno da su metode primenljive i za detekciju ovog virusa. Na osnovu rezultata prinosa procesne kontrole i utvrđenog prisustva virusa u uzorcima,&nbsp; zaključeno&nbsp; je da se ove metode mogu veoma uspe&scaron;no koristiti za detekciju virusne kontaminacije&nbsp; povr&scaron;inskih voda. Izvr&scaron;ena je igenotipizacija virusa iz odabranih uzoraka metodom sekvenciranja dela virusnog genoma. Indirektno je potvrđeno da su infekcije&nbsp;&nbsp; detektovanim virusima prisutne u populaciji životinja i ljudi. Prisustvo virusa u&nbsp;&nbsp; povr&scaron;inskim vodama i uzorcima gradske kanalizacije odražava infektivni status stanovni&scaron;tva, ali predstavlja i značajan rizik za zdravlje životinja i ljudi na području koje gravitira ispitanim vodama.&nbsp;</p> / <p>Over 100 types of pathogenic viruses are excreted in human and animal wastes. The presence of human and animal pathogenic enteric viruses in water environments reflects fecal contamination and indicates a risk to public health.&nbsp; Republic of Serbia does not implement surveillance for the presence of pathogenic human and animal viruses in surface waters and even in drinking water, neither is the established methodology of these studies in any institution in Serbia.&nbsp; Accordingly, the aim of the study was to determine and analyze the presence of human and animal viruses in surface water,&nbsp; using the latest methods&nbsp; of&nbsp; concentration and detection of the viruses.&nbsp; Within the dissertation examined the presence of the following viruses in surface waters in Vojvodina:&nbsp; Human adenoviruses&nbsp; (HAdV), noroviruses (NoV)&nbsp; and hepatitis A virus), Porcine adenovirus (PAdV) and Bovine polyomavirus (BPyV)&nbsp; and&nbsp; Hepatitis E virus (HEV).<br />A total of 108 samples of surface water and waste water were collected from October 2012 to June 2014. The paper are applied the most advanced methods and the concentration of virus detection in water, which in Serbia are not used for this purpose. The conducted tests have proven that the animal and human viruses present in surface waters in Vojvodina. The most commonly detected virus in surface water was human adenovirus (42.4%), followed by Norovirus GI&nbsp; and GII (40.4% and 15.2%),&nbsp; Porcine adenovirus&nbsp; (11,1%),&nbsp; Bovine polyomavirus&nbsp; (7.07%) and hepatitis E virus (3,0%).<br />In total of&nbsp; nine analysed sewage samples human adenovirus was detected in 44,4%&nbsp; of&nbsp; samples. The prevalence of norovirus GII and GI in sewage&nbsp; samples was&nbsp; 66,7%&nbsp; and 22,2%. Bovine&nbsp; polyomavirus was detected in one of nine samples while porcine adenovirus and hepatitis E virus were not detected in any of analyzed samples.&nbsp; Hepatitis A virus was not detected in samples, but&nbsp; it has been experimentally confirmed that the methods applicable for detection of the virus. Based on the results of process control and yield determined the presence of virus insamples, it was found that these methods can be successfully used to detect viral contamination of surface waters. Also, in these study was performed genotyping of viruses from selected samples by sequencing a part of the viral genome. Indirectly it is confirmed that the infection detected viruses present in a population of animals and humans. The presence of virus in samples of surface water and urban sewage reflects the infectious status of the population, but also constitutes a significant risk to the health of animals and people in the area that gravitates with tested waters.</p><p>&nbsp;</p>