Klinicka mikrobiologie a infekcni lekarstvi最新文献

Background: Retrospective evaluation of the frequency, efficacy, and tolerance of antiviral treatment for chronic viral hepatitis B and C (VHB, VHC) in children in Ostrava.

Material and methods: The sample included 17 children with chronic VHB, aged 3-15 years, treated with conventional interferon alpha in 1993-2008, and 11 children with chronic VHC, aged 5-17 years, of whom six were treated with interferon regimens in 1995-2016 and five used direct-acting antivirals since 2020.

Results: In the 1990s, children with chronic VHB prevailed; 12 of them were infected vertically. In the last decade, children with chronic VHC dominated, with vertical transmission found in seven children. All 17 children with chronic VHB, 15 of whom were HBeAg (hepatitis B virus e-antigen-positive), were treated with interferon alpha (IFN). HBeAg positivity disappeared in seven children during treatment or within a year after treatment and in another six patients within 15 years after treatment. Treatment tolerance was good, except for psychological problems in two children. Thirteen patients continued to be observed into adulthood, six of whom were treated with interferons or oral antivirals. HBsAg (hepatitis B virus s-antigen) disappeared in four patients aged 7-38 years. Six children with chronic VHC were treated with IFN or pegylated IFN; four received ribavirin. The virus was permanently cleared in five children, the last of whom after treatment with elbasvir and grazoprevir at the age of 18. The tolerance of IFN treatment was good, except for a 5-year-old boy who developed hypothyroidism. Direct-acting antivirals were administered to five children; the first received glecaprevir with pibrentasvir, and the other four received sofosbuvir with velpatasvir. All treatments were successful. Long-term follow-up after treatment was recommended for only three patients.

Conclusions: Antiviral treatment for chronic VHB in children has become a thing of the past thanks to VHB vaccination. However, chronic VHB persists into adulthood after infection in childhood. Currently, chronic VHC dominates in children. After successful treatment with direct-acting antivirals, further follow-up in adulthood is usually unnecessary.

The article focuses on the organization of care for patients with, or suspected of having, highly dangerous infectious diseases in the Czech Republic. It describes the activities of the National Center for Isolation and Treatment of Highly Dangerous Diseases, including its activation, patient admission, and isolation measures. The article also mentions experiences with activating the center over the past 10 years. Keywords: National Center for Isolation and Treatment of Highly Dangerous Diseases, Bulovka University Hospital, viral hemorrhagic fevers, isolation measures, bioboxes.

Viral hemorrhagic fevers are severe infections caused by selected enveloped RNA viruses from the families Filoviridae, Arenaviridae, Flaviviridae, and the order Bunyavirales. Their pathogenesis is characterized by early failure of antiviral immunity, high viremia, endothelial dysfunction, capillary leak, and coagulopathy. Clinically, they initially present as non-specific febrile illnesses, but may progress to organ dysfunction, hemorrhagic manifestations, or shock. Laboratory findings commonly include early leukopenia, thrombocytopenia, and elevated liver enzymes. The current epidemiological situation shows considerable regional variability. For many of these infections, transmission via vectors, zoonotic spread, or nosocomial transmission plays a significant role. In Europe, the risk of most hemorrhagic fevers remains low but, not negligible. Continuous surveillance of imported cases, together with access to high-quality laboratory testing, effective infection control including prevention of nosocomial spread, and vigilance in febrile patients with relevant epidemiological exposure, are essential. Limited therapeutic and vaccination options highlight the need for further research and international collaboration, as well as preparedness for the potential importation of these infections.

The Virology Department of the Czechoslovak army, established in response to the need for a specific approach to biological threats, was initially subordinated to the Military Institute of Hygiene and Epidemiology (founded in 1957), and later to the Central Military Medical Institute. Within this department, a systematic Virus Strain Bank was established that contained highly contagious viruses and bacteria used for diagnostic purposes and to develop defensive methods against biological threats. The preserved strains included viruses causing hemorrhagic fevers, encephalitis, yellow fever, and Rocky Mountain spotted fever, as well as the variola minor virus. The Virus Strain Bank enabled testing of the capabilities to detect and identify dangerous agents, as well as the development of specific and neutralizing antibodies against them. It was therefore essential for defensive and diagnostic purposes in the context of protection against the use of biological weapons. Keywords: virus strains; viral infection diagnosis, biological threat.

High consequence infectious diseases (HCIDs) are feared for their high lethality and easy interpersonal transmission, posing a particular threat to healthcare workers. This article provides a brief history and characteristics of HCIDs, the procedure for healthcare workers in the event of suspecting an HCID, the coordinating function of an epidemiologist, and the gradual involvement of all components of the integrated rescue system, leading to transporting the patient to the Department of Infectious Diseases of the Bulovka University Hospital in Prague. Activation of the Ministry of Health and the National Institute of Public Health aims to arrange HCID diagnosis in a laboratory abroad. An integral part of the measures is carrying out proper disinfection at the outbreak site and treating contacts with the HCID. Keywords: high consequence infectious diseases, outbreak, contact.

Objective: To evaluate the quality of care provided to patients with febrile neutropenia (FN) hospitalized at the Depart-ment of Infectious Diseases, Military University Hospital Prague, as a foundation for improving the management of this condition.

Material and methods: A retrospective observational analysis of patients diagnosed with the ICD-10 code D70 from 1 January 2015 to 1 June 2023. All evaluated parameters were selected primarily to facilitate the assessment of care quality and compliance with recommended practices.

Results: Of 32 evaluated patients, 19 met the criteria for FN. A history of conditions or treatments predisposing to neutropenia was noted in 74 % of patients. Seventy-four percent were admitted following evaluation or referral from an emergency department or another specialist. Blood cultures (at least two sets) were initially obtained in 80 % of cases. Antibiotics were initially administered correctly to all patients. However, considering antibiotic combinations would have been appropriate in 40 % of cases. No patients received antibiotics within one hour of initial contact with a healthcare facility. Antifungals were therapeutically administered to 58% of patients, though 37 % of these had no clear indication. A hematologist was consulted in 75 % of cases, and a stimulating factor (filgrastim) was administered in 88 % of cases. All patients were treated in isolation. An infection source was identified in 74 % of cases.

Conclusion: The analysis highlighted areas for improving the quality of care for patients with FN. Based on this study, an internal procedure is now being developed that will focus on coordination with emergency and other departments, emphasize obtaining blood cultures, and ensure the timely and correct administration of antibiotics, including their possible combinations, as well as antifungals.

Myiasis is a parasitic infestation caused by the larvae of dipteran flies, affecting living or necrotic tissues in humans and animals. It is classified into obligatory and facultative forms, depending on the relationship between the parasite and the host. Clinically, myiasis may present as cutaneous, wound, cavity, intestinal, urogenital, or blood-feeding larval infestations. Diagnosis is based on the characteristic clinical presentation, with definitive identification provided by a parasitological examination of the larvae. Treatment involves the mechanical removal of the larvae and appropriate wound care. Myiasis should be considered in the differential diagnosis of furuncular and non-healing wounds in travelers returning from tropical or subtropical regions. This article presents a case of scrotal myiasis caused by Dermatobia hominis in a traveler coming back from Ecuador. Keywords: myiasis, larvae, travel-related infection.

Acute bacterial skin and soft tissue infections represent a common clinical problem, and accurate diagnosis is crucial for initiating appropriate therapy. However, conditions such as cellulitis and erysipelas can be clinically mimicked by a variety of non-infectious conditions, including eczematous, venous, lymphatic, and autoimmune diseases. This review summarizes the key differences in clinical presentation, patient history, and laboratory findings that help distinguish true infections from their non-infectious mimickers. Special attention is given to conditions such as microbial eczema, herpes zoster, stasis dermatitis, lymphedema, vasculitis, and other less common causes. Accurate differential diagnosis is essential for preventing unnecessary antibiotic use, minimizing complications, and initiating targeted therapy. Keywords: bacterial skin diseases, soft tissue infections, cellulitis, phlegmon, erysipelas, differential diagnosis.

Skin and soft tissue infections (SSTIs) represent a diverse spectrum of conditions, including erysipelas, cellulitis, cutaneous abscesses, necrotizing fasciitis, and myonecrosis. Erysipelas and cellulitis are the most common community-acquired SSTIs. Erysipelas is typically caused by pyogenic streptococci, while cellulitis often has a staphylococcal etiology. Dia-gnosis of erysipelas and cellulitis is primarily clinical and may be supported by the NEW HAvUN scoring system. Treat-ment is based on the use of narrow-spectrum antibiotics primarily targeting gram-positive bacteria. In the Czech Republic, intramuscular forms of penicillin G (procaine penicillin G for treatment and benzathine penicillin G for prophylaxis) are used for erysipelas in certain situations for historical reasons. For cellulitis, oxacillin, flucloxacillin, or cefazolin are commonly employed. The use of broad-spectrum antibiotics is only justified when an atypical etiology is suspected (including gram-negative or anaerobic bacteria), in high-risk patient groups, or following animal bites or exposure to aquatic environments. The article also lists second-line antibiotics for patients with a beta-lactam allergy. The standard duration of antibiotic therapy should not exceed 10 days, and it is often shorter (five to seven days). In cases of necrotizing fasciitis or myonecrosis, early diagnosis, prompt surgical intervention, intensive care, and antibiotic treatment - typically a combination of a beta-lactam and clindamycin, based on the likely pathogen and entry site - are crucial. The text highlights the importance of sound clinical judgment and appropriate antibiotic use as essential strategies to prevent the overuse of broad-spectrum antibiotics and curb antimicrobial resistance. Keywords: erysipelas, cellulitis, skin abscess, necrotizing fasciitis, myonecrosis.

Capnocytophaga spp. are typical members of the commensal microflora of the oral cavity. However, C. canimorsus can also be a dangerous pathogen, often causing fatal systemic infections, usually from contact with the saliva of dogs or cats. The article discusses the clinical significance of zoonotic infections with this bacterium as well as its natural occurrence, pathogenic adaptation, and the current problem of antimicrobial resistance. Keywords: Capnocytophaga spp., zoonosis, bite wound infection, oral microflora.