Klinicka mikrobiologie a infekcni lekarstvi最新文献

Aims: To describe the symptoms and complications of influenza A in seniors in the 2018-2019 influenza season.

Material and methods: A retrospective analysis of data on 84 seniors with laboratory confirmed influenza A between 1 October 2018 and 30 April 2019 who were tested for this infectious disease in the University Hospital Pilsen.

Results: Influenza A was diagnosed in 84 seniors during the period under review. The most common symptoms were fever (69 cases; 82.14 %) and cough (60 cases; 71.43 %). These two symptoms combined occurred in more than half of patients over 65 years of age (51 cases; 60.71 %). Other common symptoms included general weakness (58 cases; 69.05 %) and fatigue (57 cases; 67.86 %). The other symptoms occurred in less than half of cases. The most common complication was pneumonia (36 cases; 42.86 %). Bacterial etiology was confirmed in 13 cases and the most commonly occurring pathogens were Klebsiella pneumoniae and Streptococcus pneumoniae. Another common complication of influenza was acute respiratory insufficiency in pneumonia, heart failure or exacerbation of chronic respiratory disease. The mortality rate of seniors in our sample was 17.86 % (15 cases).

Conclusion: In the senior population, the most common symptoms of influenza are a rapid onset of fever and dry cough. The study has confirmed that the most common complication is pneumonia. Furthermore, exacerbations of various chronic diseases of the cardiovascular and respiratory systems, worsening of chronic renal insufficiency and urinary tract infections were common. The most effective prevention of the development of influenza and its complications is the available quadrivalent vaccine.

Objectives: To provide an overview of the most common bacterial species isolated from blood cultures in the University Hospital Olomouc in the years 2015-2019 and their antibiotic resistance patterns.

Material and methods: The data were obtained from the laboratory information management system ENVIS LIMS. The results were analyzed retrospectively for the period from January 1, 2015 to December 31, 2019. Among positive blood cultures, the prevalence of bacterial species was assessed and the most frequent species were evaluated for resistance to selected antibiotics. Each sample was processed using standard microbiology methods with the MALDI-TOF MS system. Susceptibility to antibiotics was tested with the microdilution method according to the EUCAST recommendations.

Results: Over the study period, a total of 3 400 isolates from blood cultures were included. Coagulase-negative staphylococci were the most prevalent (37 %), followed by Escherichia coli (16 %), Klebsiella pneumoniae (9 %), Staphylococcus aureus (7 %), Streptococcus spp. (5 %), Pseudomonas aeruginosa (4 %), Enterobacter cloacae (2 %), Enterococcus faecalis (2 %) and Enterococcus faecium (2 %). Resistance of E. coli to 3rd generation cephalosporins, piperacillin/tazobactam, gentamicin and fluoroquinolones ranged from 7 % to 33 %. A high percentage of Klebsiella pneumoniae strains (33 %-65 %) was resistant to the above antibiotics. The prevalence of methicillin-resistant Staphylococcus aureus reached 3-7 %. Pseudomonas aeruginosa exhibited resistance to piperacillin/tazobactam, ceftazidime, cefepime, meropenem, ciprofloxacin and gentamicin ranging from 3 % to 46 %.

Conclusion: Knowing the prevalence of bacterial species from blood cultures and their antimicrobial resistance patterns is important for empirical antibiotic therapy in case of an existing infection. It is advisable to conduct such epidemiological studies as part of antibiotic stewardship.

Objective: Group A rotavirus (RVA) is one of leading causes of gastroenteritis in children under five years of age and is also an important nosocomial pathogen. In Europe, the most prevalent genotypes of RVA are G1P[8], G2P[4], G3P[8], G4P[8], G9P[8] and G12P[8]. Severe dehydration is the most important complication of RVA gastroenteritis. Each year, rotavirus infection is responsible for 3,000 to 5,000 hospitalizations of children in the Czech Republic. The aim of this study was to detect rotaviruses in patients with suspected acute viral gastroenteritis.

Methods: A total of 1 566 stool samples were obtained from patients with acute gastroenteritis from March 2016 to December 2018. All samples were tested by the enzyme immunoassay, rapid immunochromatographic test and quantitative reverse transcription PCR assay to detect RVA. All RVA positive samples were G- and P-typed by Sanger sequencing.

Results and conclusion: RVA was detected in 13.7 % of the samples (214/1566). The incidence of RVA was 58.9 % (126/214) in males and 41.1 % (88/214) in females. The percentages of positivity ranged from 1 % to 33 % in different age groups. The highest proportion of positive patients was in the age group 4-5 years, 32.6 % (30/92). There was a significant difference in the incidence of rotaviruses between different age groups (p = 0.3946). The prevalent RVA genotypes were G1P[8], G9P[8], G3P[8], G2P[4] and G8P[8]. The detection of the G8P[8] genotype was unusual. The obtained results show that despite the possibility of vaccination, the incidence of RVA infection remains high in the Czech Republic.

The article discusses possible prevention and prophylaxis of infectious diseases affecting the course of pregnancy with respect to the mother, fetus and newborn. Also mentioned are diseases for which there is no vaccination. The options for prevention targeted at the periods before and during pregnancy and after delivery are explained. Finally, practical procedures related to vaccination and diagnosis of infectious diseases in women of childbearing age are presented.

Background: The aim was to do an internal audit of gastrointestinal pathogen detection at the Department of Medical Microbiology, Motol University Hospital between the years 2014 and 2018 and to test two commercial multiplex molecular biology assays potentially improving the diagnostic process and reducing costs.

Material and methods: Based on data from a laboratory information system (LIS), a total of 45,888 samples were identified which had been tested for the presence of gastrointestinal pathogens using culture, immunochromatographic, microscopic and molecular biology techniques between 2014-2018. Novel multiplex molecular biology detection was used to test 182 nucleic acid isolates obtained from stool samples with the Enteric Viruses (8-well) assay (Viral Panel, EVP) or Faecal Pathogens M (16-well) assay (Microbial Panel, FPM) manufactured by AusDiagnostics.

Results: The LIS data showed 6.2 % of positive pathogens causing diarrhea from all tested samples (detection rates: 4.5 % for bacterial agents, 21.6 % for viral agents and 0.4 % for parasitic agents). Valid samples (98.9 % of all tested samples) tested by the molecular biology technique yielded, in descending order: C. difficile toxin B (19 %), norovirus (9 %), astrovirus (8 %), Campylobacter (7 %), sapovirus (6 %), Yersinia enterocolitica (6 %), rotavirus (4 %), enterovirus (3 %), Aeromonas (3 %), adenovirus (2 %) and Salmonella (1 %). There was found at least 1 additional new positive detection in 27 % of stools tested by the Viral Panel and in 40 % of stools tested by the Microbial Panel in comparison with the traditional approach. Introducing the panels into routine diagnostic practice will not reduce the costs.

Conclusions: The introduction of novel multiplex molecular biology assays for detecting gastrointestinal pathogens will considerably increase pathogen detection rates even though the costs will be higher for the Department of Medical Microbiology.

Cryptococcal meningitis is a severe neurological infection caused by the yeast Cryptococcus neoformans. It often occurs as an opportunistic infection; rarely, it may be seen in healthy people as well. The most common source of the infection is inhalation of infected bird droppings. The cryptococci may persist in the lungs and nearby lymph nodes for a long time. There are no or mild clinical manifestations of the pulmonary infection. The disease often manifests only after the cryptococci penetrate into the CNS. The case report documents the development of cryptococcal meningitis in an immunocompetent patient. It was diagnosed by microscopic detection of the yeast in the cerebrospinal fluid. The finding was confirmed by detecting cryptococcal DNA in the cerebrospinal fluid and culture. Despite immediate initiation of antifungal therapy and intensive care, the patient died.

Antiretroviral therapy represents an essential element in the approach to treatment and prevention of human immunodeficiency virus (HIV). It has changed the fatal disease to a manageable chronic condition and is the most effective prevention of its human-to-human transmission. Knowledge regarding biological characteristics of the virus, its behavior in a human host and our understanding of these phenomena have been extended by clinical experience, new clinical data and recent scientific progress. The development of new drugs becomes a modifier for the existing therapeutic strategy and preference. Certain points are more specific than in the previous guidelines. Definitions of certain clinical and laboratory conditions have been specified more accurately. The indications of specific antiretroviral agents and pitfalls of their use in lifelong antiretroviral treatment are also described more in detail. The document is a result of a general consensus among infectious disease specialists working with HIV patients in the Czech Republic. It should serve as a basic instrument for clinicians recommending treatment of HIV infection as well as a foundation for the society when dealing with both state authorities and health care payers.

Objective: The diagnosis of Bartonella henselae by polymerase chain reaction (PCR) in lymph nodes removed in 10 patients with serologically confirmed evidence cat-scratch disease.

Material and methods: The 2015-2018 group consisted of 10 patients with serologically confirmed cat-scratch disease, all of them having positive IgG antibodies and 6 patients also positive IgM antibodies against B. henselae. The group included 4 men and 6 women, 7 children and 3 adults, aged 5-52 years. Eleven lymph nodes obtained from the 10 patients were formalin-fixed paraffin-embedded. Variants of granulomatous inflammation were found in 9 patients; a 13-year-old boy had Hodgkin's lymphoma. DNA isolation was performed with cobas® DNA Sample Preparation Kit (Roche). DNA of Bartonella spp. was detected by real-time PCR with BactoReal® Kit Bartonella spp. (Ingenetix) detecting the gltA gene specific for the genus Bartonella.

Results: Four of the 10 patients tested positive or borderline positive for Bartonella when their histological material was analyzed by PCR. One patient with 2 lymph nodes examined showed a positive result for only 1 lymph node. One adult male had a positive result; three children showed borderline positive results. Of those, two patients had suppurative granulomatous and the other 2 patients had necrotizing suppurative granulomatous inflammation as histological findings. All 4 patients had positive IgM antibodies against B. henselae. The boy with lymphoma had a negative PCR result.

Conclusion: Serological tests combined with histological examination of lymph nodes and PCR may improve the diagnosis of cat- scratch disease.

Lactic acidosis is a rare but serious adverse event linked to treatment with linezolid, an oxazolidinone antibiotic. Presented is a case of a 67-year-old man treated for 26 days with linezolid for staphylococcal osteomyelitis of the right foot with subsequent sepsis. During the course of treatment, severe lactic acidosis developed, requiring hospitalization in an intensive care unit. The likely mechanism of this potentially life-threatening complication is discussed.

Invasive aspergillosis (IA) is a major cause of morbidity and mortality in immunocompromised patients. Given the rising numbers of patients at risk of opportunistic infections, there has been a significant increase in Aspergillus infections in recent years. Patients most at risk are mainly those with prolonged neutropenia or receiving long-term corticosteroid or other immunosuppressive thera pies and those with impaired pulmonary defense. Relatively recently, critically ill patients without traditional risk factors were also classified as at-risk, that is patients in intensive care units, those with chronic obstructive pulmonary disease, post-flu and so on. Chronic obstructive pulmonary disease is one of the most common predisposing conditions due to frequent Aspergillus airway colonization. Other significant risk factors for IA are decompensated liver disease and cirrhosis, AIDS, corticosteroid treatment, impaired mucociliary transport after cure from pneumonia (both bacterial and viral), immune deficiency in long-lasting diseases and autoimmune disorders. Additionally, various immunosuppressive drugs increase the risk of IA (e.g. tumor necrosis factor blockers). The case reports describe two patients who developed disseminated aspergillosis after a severe illness, with the right diagnosis being made only at autopsy. The author´s aim is to draw attention to the need to consider IA also in patients who initially do not appear to be at risk for disseminated fungal infection.