Klinicka mikrobiologie a infekcni lekarstvi最新文献

Introduction: HEV infection is perceived as the cause of acute hepatitis in endemic areas. In addition, it may also manifest as a possible trigger of AD or acute-on-chronic liver failure (ACLF).

Objectives: To determine the prevalence of HEV infection as a trigger of AD/ACLF in patients admitted for decompensated ACLD (dACLD).

Methods: A retrospective study; data analysis of consecutive patients with dACLD admitted to a liver unit. Study interval: August 2016 - October 2017.

Inclusion criteria: AD, defined as the interval between the first manifestations of decompensation and admission ≤ 4 weeks; an anti-HEV ELISA antibody assay in the IgG and IgM classes (HEV Ab ELISA, DRG Instruments GmbH, Germany).

Exclusion criteria: chronic decompensation of liver cirrhosis, insufficient data. Recorded variables: gender, age, etiology of ACLD, Model for End-Stage Liver Disease (MELD) score, Child-Turcotte-Pugh score (CTPS), anti-HEV IgG and IgM, ACLF 0-3, length of stay (LOS) in the hospital, mortality: in-hospital mortality (IHM), 30-day, 6-month, 1-year and overall mortality.

Results: Over the 15-month study interval, a total of 212 patients (pts) were admitted for dACLD, including 115 with AD (54 %). The final analysis comprised 91 pts with a mean age of 53.3 years (y); 56 % were men.

Etiology: ALD 81 %, autoimmune diseases 7 %, HCV 5 %, non-alcoholic steatohepatitis 3 %, HBV 2 %, others 2 %. The mean MELD score and CTPS were 22.5 and 10.5 points (p), respectively. HEV infection as a possible trigger of AD was found in 9 % of pts (AD 75 %, ACLF 1-12.5 %, ACLF 3-12.5 %). Between HEV-positive and HEV-negative patients, there were no significant differences in age (p = 0.11), gender (p = 0.13), median MELD score (p = 0.42), median CTPS (p = 0.57), LOS (p = 0.56), overall survival (p = NS), IHM (p = NS), 30-day (p = NS), 6-month (p = NS), 1-year (p = NS) and overall mortality (p = NS).

Conclusion: The prevalence of HEV infection as a trigger of AD was 9 %. There were no significant differences in recorded variables, including mortality, between HEV-negative and HEV-positive patients.

The national guideline aims to highlight the latest knowledge about clinical manifestations of the infection, to summarize the diagnostic algorithm and to recommend the appropriate antibiotic therapy with respect to evidence-based medicine. The recommendations are consistent with most European guidelines as well as those published by the IDSA. The guideline provides the most recent information on the epidemiology, etiology and pathogenesis of Lyme borreliosis, dermatological, neurological and musculoskeletal involvement, the appropriate diagnostic procedure and prevention. Some information is also provided about post-treatment Lyme disease syndrome. Recommended oral and intravenous antimicrobials are listed in a table showing the doses and duration of therapy. The guideline also mentions diagnostic methods to be avoided or whose results should be interpreted with caution. Although the guideline cannot account for all individual variations among patients, it may provide instructions to physicians in typical and frequent clinical situations.

Objectives: Staphylococcus epidermidis and coagulase-negative staphylococci generally are important causative agents of hospital-acquired infections. A significant role in this process is played by their common ability to form biofilm, a highly organized community of microorganisms adhering to inert surfaces. The study aimed to determine the prevalence of these bacterial strains and their ability to form biofilm at the Department of Hemato-Oncology, University Hospital Olomouc.

Material and methods: Over a period of 12 months, samples of air and swabs from surfaces and staff members were collected. The samples were subjected to standard microbiology tests; coagulase-negative staphylococci were identified. Staphylococcus epidermidis strains were confirmed by polymerase chain reaction and subsequently tested for biofilm formation.

Results and conclusions: Coagulase-negative staphylococci were found in 81 samples, most commonly swabs from staff members. S. epidermidis accounted for 60 % of all positive results; it was most frequently isolated from surface swabs. Almost half of S. epidermidis strains were able to form biofilm. These strains were found in the environment characterized by cleanliness classes FED-STD-209E (USA) - 10 000 and FED-STD-209E (USA) - 100 000. Thus, they pose a risk for immunocompromised patients staying there. Since coagulase-negative staphylococci were also found in healthcare staff of the department, the staff members may play a key role in the transmission of these microorganisms to patients.

Introduction: The microbiological aspect of a relationship between pets (dogs/cats) and their owners is mainly concerned with the incidence of the shared fungal species that can be potential pathogens. Since sharing homes with pets is very popular in the Czech Republic, there is an increased possibility of communication between microbiota of the two macroorganisms (the pet and the owner). The aim of the study was to determine, based on the close relationship between pets and humans, the biodiversity of shared fungi, also with respect to previous antimicrobial therapy.

Methods: A total of 103 samples were collected from 20 pairs (20 owners, 16 dogs and 4 cats). All owners completed a questionnaire with their pets' veterinarians. In owners, swabs were collected from the nasal mucosa, armpit and interdigital spaces of the foot. In pets, swabs were obtained from the external auditory meatus and nasal mucosa. In individuals with skin lesions, samples were also collected from the affected areas. Fungal species were identified by culture and microscopy methods and confirmed by matrix-assisted laser desorption/ionization - time of flight (MALDI-TOF) mass spectrometry. Statistical methods were used to correlate the closeness of relationship with the number of shared fungal species and to correlate previous antimicrobial therapy with the number of shared species of microscopic fungi.

Results: Analysis of the questionnaire found that 65 % of owners who participated in the study kept more pets at home than only the tested one. In the previous year, 5 % of pets and 5 % of owners received antimicrobial therapy. As many as 45 % of dogs or cats slept in their owners' beds and 80 % rested on a sofa together with their owners. Also, 45 % of owners had their faces licked by pets. Eighty percent of pets were fed with several types of food (dry food and cooked food). Further, 70 % of pets lived permanently with their owners in the same household. A total of 45 microscopic fungi species were isolated, of which 15 species occurred in both macroorganisms (pets and humans). Thirty-two species were identified from human and 28 species from animal samples. The most frequent species was the yeast Candida albicans, isolated from 30 samples. From the human nasal mucosa, only four species were isolated. The richest biodiversity was observed in interdigital space samples (26 fungal species). Once again, the most frequent fungal species was C. albicans (8 cases). The most numerous animal samples were obtained from the external auditory meatus. There, the most frequent species was Malassezia pachydermatis (17 cases). In seven pairs, microscopic fungi were shared. Of those, two pairs shared two spe-cies and five pairs shared one species. A total of five fungal species were shared, most often the yeasts C. albicans and Geotrichum candidum.

Conclusion: The closeness of the human-pet relationship

The review describes important bacterial pathogens, namely enterococci, focusing on their resistance to glycopeptides. Presented are the basic phenotypes and genotypes of vancomycin-resistant enterococci and options for antibiotic therapy of infections with their etio-logical role. At the same time, their prevalence in the Czech Republic is characterized based on data from the EARS-Net and studies available in the literature. Finally, potential approaches to preventing the spread of these dangerous multidrug-resistant bacteria are defined.

Objectives: The aim of this study was to monitor characteristics of Shiga toxin-producing Escherichia coli (STEC) obtained from animals according to the serogroup they belonged to, Shiga toxin type and subtype and adhesion factor intimin. Then, based on the results, to evaluate the occurrence of Shiga toxin subtypes and their possible significance for humans.

Materials and methods: The study included 131 STEC strains isolated from rectal swabs from cattle (80) and pigs (51) sampled on farms in the Czech Republic from 2000 to 2017. Selected strains differed in origin and serogroup. The presence of Shiga toxins, intimin and the Shiga toxin subtypes stx1a, stx1c, stx1d, stx2a, stx2b, stx2c, stx2d, stx2e, stx2g was determined by PCR.

Results: The stx1 gene was confirmed in 33 % of the strains (43/131), the stx2 gene in 55 % (72/131) and 16 strains carried the genes for both toxins simultaneously (12 %). Strains harboring the eae gene were detected in 46 (35 %) cases, mostly in rectal swabs from cattle. STEC from cattle belonged to 21 different serogroups. The presence of Shiga toxin 1 (55; 69 %) predominated in these strains, with subtypes stx1a (54) and stx1d (1). Shiga toxin 2 was confirmed in 39 of the bovine strains (49 %), with the following subtypes: stx2a (9), stx2e (6), stx2g (3), stx2a, stx2c (5), stx2a, stx2b (1) and stx2c, stx2d (1). Also combinations of stx1a, stx2a (12) and stx1a, stx2c (2) were detected. STEC from pigs belonged to 5 different serogroups. Shiga toxin 2 was most frequently detected (49; 96 %), with subtypes stx2e (42) and stx2a (7). Shiga toxin 1 was detected in 4 strains (8 %), as subtypes stx1a (1) and stx1c (1) and also in the combination stx1a, stx2a (2).

Conclusion: STEC strains isolated from cattle, compared to those from pigs, belonged to a larger spectrum of serogroups, they more often carried adherence factor intimin and the diversity of Shiga toxin subtypes was higher, including those associated with serious human diseases. In the set of isolates from pigs, the stx2e gene predominated; its significance for human health has not been fully clarified yet.

We present a case of a 17-year-old female with anti-NMDAR encephalitis probably associated with vaccination against yellow fever. Her symptoms occurred 27 days after vaccination against yellow fever. Anti-NMDAR encephalitis manifested as acute psychosis, memory loss and catatonia following fever with complex partial epileptic seizures. Interictal electroencephalogram showed slow-wave delta background activity with "delta brushes". The diagnosis was confirmed by NMDAR antibody positivity in serum and cerebrospinal fluid. Since ovarian teratoma, as the most common cause of anti-NMDAR encephalitis, did not develop within five years from its onset, the association with vaccination against yellow fever seems to be highly probable.

We present a case of a 17-year-old female with anti-NMDAR encephalitis probably associated with vaccination against yellow fever. Her symptoms occurred 27 days after vaccination against yellow fever. Anti-NMDAR encephalitis manifested as acute psychosis, memory loss and catatonia following fever with complex partial epileptic seizures. Interictal electroencephalogram showed slow-wave delta background activity with "delta brushes". The diagnosis was confirmed by NMDAR antibody positivity in serum and cerebrospinal fluid. Since ovarian teratoma, as the most common cause of anti-NMDAR encephalitis, did not develop within five years from its onset, the association with vaccination against yellow fever seems to be highly probable.

Hospital-acquired pneumonia (HAP) is an infection of the lung parenchyma. It is the second most frequent nosocomial infection and the leading cause of death from infection in critically ill patients. Hospital-acquired and, particularly, ventilator-associated pneumonia prolong the hospital stay and increase treatment costs. The clinical signs of pneumonia are rather non-specific, with limited possibilities to distinguish the lung condition from other nosological entities. The yield, effectiveness and cost of new rapid diagnostic procedures as well as early biochemical markers specific for pneumonia have not been sufficiently verified and clinical translation of technological innovations is slow. In bedside clinical practice, the diagnosis continues to be based on clinical examination together with imaging methods, most frequently X-ray. The spectrum of etiologic agents changes, with an increase in the prevalence of multidrug-resistant (MDR) bacterial pathogens. Initial antibiotic therapy, particularly in critically ill ventilated patients, needs to include broad-spectrum agents due to the risk of the presence of MDR bacteria. The likelihood of successful treatment may be increased by regular updates of recommendations for adequate initial antibiotherapy with regard to the epidemiological situation and knowledge of bacterial resistance to antimicrobials in a particular hospital and region. As part of the current valid guidelines, recommendation were newly translated; however, their level of evidence is often very low and the strength of recommendation is mostly weak or moderate. Their benefit to everyday practice is questionable. The article points to changes brought about by the recent European guidelines published in fall 2017 and summarizes current issues concerning HAP pathogens in intensive care units in the Czech Republic.

We report a case of a 39-year-old male admitted for respiratory failure. On admission, the patient was diagnosed with advanced HIV infection and Pneumocystis jirovecii pneumonia (PJP). The patient's condition improved following specific PJP therapy but then deteriorated. The patient was subsequently diagnosed with cytomegalovirus pneumonitis and treated with ganciclovir. The severe course of both opportunistic infections required long-term care at an intensive care unit. Despite complications, the patient was discharged after 108 inpatient days in a stable clinical condition. The case demonstrates a rare coincidence of PJP and cytomegalovirus pneumonitis while also emphasizing the importance of correct diagnosis, treatment and interdisciplinary care which, despite poor prognosis, may lead to successful cure of serious simultaneous opportunistic infections in AIDS.