{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T23:04:57Z","timestamp":1784761497094,"version":"3.55.0"},"reference-count":49,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,3,15]],"date-time":"2025-03-15T00:00:00Z","timestamp":1741996800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Ministry of Education, Science, and Technological Development of the Republic of Serbia","award":["451-03-68\/2020-14\/200156"],"award-info":[{"award-number":["451-03-68\/2020-14\/200156"]}]},{"name":"Ministry of Education, Science, and Technological Development of the Republic of Serbia","award":["COVANSA"],"award-info":[{"award-number":["COVANSA"]}]},{"name":"Science Fund of the Republic of Serbia","award":["451-03-68\/2020-14\/200156"],"award-info":[{"award-number":["451-03-68\/2020-14\/200156"]}]},{"name":"Science Fund of the Republic of Serbia","award":["COVANSA"],"award-info":[{"award-number":["COVANSA"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Viruses"],"abstract":"<jats:p>Background\/Objectives: Syncope is a common clinical occurrence, with neurally mediated and orthostatic types accounting for about 75% of cases. The exact pathophysiological mechanisms remain unclear, with recent evidence suggesting autonomic nervous system damage and a potential infectious etiology. This study aimed to examine the role of infection in the development of syncope and orthostatic hypotension (OH). Methods: The cross-sectional study included 806 patients from the Neurocardiological Laboratory of the Institute for Cardiovascular Diseases \u201cDedinje\u201d. Patients were divided into three groups: unexplained recurrent syncope (n = 506), syncope with OH during the head-up tilt test (HUTT) (n = 235), and OH without a history of syncope (n = 62). All participants underwent the HUTT, and 495 underwent serological testing for various microorganisms. Data were analyzed using chi-squared tests and binary and multinomial logistic regression. Results: The HUTT was positive in 90.6% of patients with syncope and OH, compared with 61.6% with syncope alone (p &lt; 0.001). Serological testing revealed that 57.85% of syncope patients, 62.9% of syncope with OH patients, and 78% of OH patients had positive IgM antibodies to at least one microorganism. Multivariate analysis indicated that IgM antibodies to Coxsackievirus and Epstein\u2013Barr virus were significant predictors of OH. Conclusions: This study demonstrated a potential association between infections and syncope\/OH. Further investigation into the role of infectious agents in autonomic dysfunction is warranted to clarify the underlying mechanisms of syncope and OH.<\/jats:p>","DOI":"10.3390\/v17030427","type":"journal-article","created":{"date-parts":[[2025,3,17]],"date-time":"2025-03-17T07:49:57Z","timestamp":1742197797000},"page":"427","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["A New Approach to the Etiology of Syncope: Infection as a Cause"],"prefix":"10.3390","volume":"17","author":[{"given":"Branislav","family":"Milovanovic","sequence":"first","affiliation":[{"name":"Institute for Cardiovascular Diseases \u201cDedinje\u201d, 11000 Belgrade, Serbia"},{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-5090-6029","authenticated-orcid":false,"given":"Nikola","family":"Markovic","sequence":"additional","affiliation":[{"name":"Institute for Cardiovascular Diseases \u201cDedinje\u201d, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1709-8449","authenticated-orcid":false,"given":"Masa","family":"Petrovic","sequence":"additional","affiliation":[{"name":"Institute for Cardiovascular Diseases \u201cDedinje\u201d, 11000 Belgrade, Serbia"},{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vasko","family":"Zugic","sequence":"additional","affiliation":[{"name":"Institute for Cardiovascular Diseases \u201cDedinje\u201d, 11000 Belgrade, Serbia"},{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milijana","family":"Ostojic","sequence":"additional","affiliation":[{"name":"Institute for Cardiovascular Diseases \u201cDedinje\u201d, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milica","family":"Dragicevic-Antonic","sequence":"additional","affiliation":[{"name":"Institute for Cardiovascular Diseases \u201cDedinje\u201d, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milovan","family":"Bojic","sequence":"additional","affiliation":[{"name":"Institute for Cardiovascular Diseases \u201cDedinje\u201d, 11000 Belgrade, Serbia"},{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1883","DOI":"10.1093\/eurheartj\/ehy037","article-title":"2018 ESC guidelines for the diagnosis and management of syncope","volume":"39","author":"Brignole","year":"2018","journal-title":"Eur. 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