Epidemiologie Mikrobiologie Imunologie最新文献

Aim: The aim of the study was to describe the prevalence of HIV-1 subtypes and HIV-1 strains resistant to antiretroviral therapy (ART) in HIV-positive persons newly diagnosed in Slovakia in 2019-2021.

Materials and methods: The study group consisted of 184 HIV-positive naïve patients newly diagnosed in Slovakia from 2019 to 2021. The viral HIV-1 RNA was isolated from plasma by the QIAamp Viral RNA Mini Kit (QIAGEN, Germany). For RT-PCR and sequencing of the HIV pol region, in-house procedures were used according to the ANRS AC11 protocol for RT (reverse transcriptase), PRO (protease), and IN (integrase) [ANRS AC11 Resistance Study Group, 2015]. Analysis of sequences was performed using Sequencing Analysis Software v5.3 (Applied Biosystems®). HIV sequences were manually edited using BioEdit (version 7.2.5), compared with consensus HIV-1 sequences in the Los Alamos Sequence Database (URL 2), aligned using CLUSTAL W [Labarga et al., 2007] and BioEdit software packages (version 7.2 .5) [Hall, 1999]. HIVDB Algorithm (version 9.0) of the Stanford HIV Drug resistance database (URL 1.) was used for sequence evaluation. For HIV-1 subtype analysis, the REGA HIV-1 Subtyping Tool [De Oliviera et al., 2005] and phylogenetic analysis MEGA X [Kumar et al., 2018] were used.

Results: Phylogenetic analyses performed in samples of 184 persons revealed the most prevalent subtype B (129/184, 70.11%), detected to the greatest extent in the population of men who have sex with men (MSM) (96/129 74.42%). Concerning non-B subtypes (55/184, 29.89%), subtype A was found with the highest prevalence (48/184, 26.09%) compared to subtype F (F1) (3; 1.63%), C (1; 0.54%) and circulating recombinant forms CRF02_AG (2; 1.09%), CRF01_AE (1; 0.54%). In 9.24% (17/184) of samples, 25 mutations clinically relevant and associated with HIV resistance ART were detected, of which 7.07% (13/184) to reverse transcriptase inhibitors, 1.66% (3/181) to protease inhibitors and 1.32% (2/151) to integrase inhibitors. In addition, multiclass resistance was present in 1.63% (3/184) of patients. Mutations associated with HIV resistance to ART were found in 9.30 % of persons infected with subtype B.

Conclusion: Our study confirmed ongoing highest prevalence of subtype B with a slightly decreasing trend compared to last years. Detection of mutations causing HIV resistance to ART underlines the need for resistance testing in naïve patients even before the initiation of ART in Slovakia.

Objectives: The aim of this work was to analyze the relationship between new cases of clinical tick-borne encephalitis (TBE) and various meteorological and seasonal predictors.

Material and methods: The modelling is based on national data from the Czech Republic for the period 2001-2016 in daily resolution, namely on average temperatures, average relative air humidity and the number of TBE cases classified according to the date of the first symptoms. Four variants of a negative binomial model from the generalized additive model class are used. The basic model relates the occurrence of TBE to the lagged ambient daily average temperature and daily average relative air humidity and their interaction with the lag reflecting the incubation period and other factors. The lag value was estimated via the optimization procedure based on Akaike information criterion. The model also includes the effect of the season and the effect of the day of the week. To increase the biological plausibility, the basic model has been expanded to account for possible time-varying effects of meteorological variables and to incorporate multiple lags.

Results: The most statistically significant effect is the within-year seasonality and then the interaction of the temperature and relative air humidity. The relationship of both meteorological factors and their interactions vary throughout the activities season of the hostquesting Ixodes ricinus. This also changes the conditions of occurrence of the new clinical cases of TBE. The time-varying effect of meteorological factors on the incidence of TBE shows non-trivial changes within a year. In the period before the middle of the calendar year (around the week 22) the effect decreases, then it is followed by an increase until the week 35.

Conclusion: Flexible models were developed with quantitatively characterized effects of temperature, air humidity and their interaction, with the delay of the effect estimated through the optimization process. Performance of the model with multiple lags was checked using independent data to verify the possibility of using the results to improve the prediction of the risk of clinical cases of TBE uprise.

Background and aim: Haemolytic uraemic syndrome (HUS) is a triad of haemolytic anaemia, thrombocytopaenia, and acute kidney injury. It is a leading cause of acute kidney injury in children and has a high rate of long-term sequelae. Streptococcus pneumoniae-associated HUS (SpHUS) is a rare complication from pneumococcal disease. This article aims to systematically review SpHUS following the global introduction of pneumococcal conjugate vaccines (PCVs).

Material and methods: A comprehensive literature search was conducted in MEDLINE, EMBASE, and the Cochrane library from 1st January 2000 to 13th April 2022.

Results: Thirteen studies were included in this review, involving a total of 7,177 children with HUS, of which 336 cases were associated with Streptococcus pneumoniae. SpHUS accounted for 4.8% of all HUS cases, in which most patients were younger than 24 months old. Nine studies (80.4%, 281) were during the country's PCV era, whereas 4 studies (19.6%, 66) were before the introduction of PCV into the national vaccination programme. Pneumonia was the commonest clinical presentation (77.3%; 75/97), followed by septicaemia (33.0%; 32/97), and meningitis (29.9%; 29/97). Most cases presenting with pneumonia were complicated by empyema or pleural effusion (54.4%, n=49/90). Only 5 studies reported the isolated serotypes, with the most prevalent serotype being 19A (44.4%, n=20/45), followed by serotype 3 (17.8%, n = 8/45) and 7F (6.7%, n = 3/45). Of those reporting fatality, there were 12 deaths with a fatality rate of 9.8% (n = 12/122).

Conclusion: SpHUS is rare, but commonly presents in children younger than 2 years old. There remains a high risk of long-term complications and relatively high mortality rate even in the era of conjugate vaccines.

The NRL for Streptococcal Infections performed serotyping of 1038 isolates of Streptococcus agalactiae from 972 patients by the latex agglutination method in 2008–2020.Forty-three isolates (4.4%) whose serotyping failed were classified as non-typeable. The aim of the present study was to determine the genotype of these non-typeable isolates using multiplex polymerase chain reaction (mPCR). Genotyping was successful in the entire set of 43 non-typeable isolates. The most common genotype was V (41.9%), followed by Ia (20.9%). The isolates serotyped by latex agglutination were predominantly assigned to serotype III (29.2%) and V (26.2%). Complete data were obtained on the prevalence of S. agalactiae serotypes/genotypes in the Czech Republic in 2008–2020. Monitoring the serotype and genotype distribution of the pathogen is a prerequisite for the introduction of a potential vaccine against S. agalactiae into clinical practice.

This study describes a cohort of 223 patients who received anti-S protein monoclonal antibody (mAb) treatment for COVID-19 after having met the indication criteria set by the national guidelines in the Czech Republic at the time. The authors compare the vaccinated and unvaccinated subpopulations of this cohort. The results show that most of the patients (73.5%) already had significant circulating levels of anti-S antibodies detectable at the time of treatment. The authors confirm a positive correlation between number of vaccine doses and S-protein antibody levels. The data show, that vaccinated patients are overall less likely to be hospitalized than unvaccinated ones. The authors recommend a change in the national guidelines for mAb treatment in the Czech Republic.

Objective: To report on a unique combination of cerebral toxoplasmosis and ocular toxoplasmosis in an HIV-positive patient in Slovakia.

Methods: A 35-year-old heterosexual patient who presented with headache and major seizures underwent computed tomography (CT) and magnetic resonance imaging (MRI). Based on clinical findings, serological tests for toxoplasmosis were performed on serum and ocular fluid specimens. PCR was also used to detect Toxoplasma gondii and cytomegalovirus DNA. Goldmann and Witmer coefficient calculation was applied to demonstrate the synthesis of intraocular IgG antibodies.

Results: CT and MRI revealed cystic lesions suspected of metastasis in the occipital and temporal regions, and we searched for the primary tumor. After vision loss in the left eye, which rapidly progressed to complete blindness, an eye examination detected macular edema. Anti-edema treatment was initiated. HIV positivity with a very low CD4 T-cell count (20/μL) was found, and the viral load was 100 400 HIV-RNA copies/ml. The serum was positive for anti-Toxoplasma IgG antibodies (> 200 IU/mL), IgM negative, and IgA borderline. As toxoplasmic encephalitis and retinitis were suspected, antitoxoplasmic therapy with pyrimethamine, spiramycin, and folinic acid was started. The ophthalmologist considered cytomegalovirus retinitis, which was not confirmed by serology or PCR. In contrast, the presence of IgG antibodies in ocular fluid and serum with the calculation of the Goldmann-Witmer coefficient (GW = 32) as well as PCR DNA positivity pointed to Toxoplasma gondii as the etiological agent. Follow-up MRI scan confirmed regression of the pathological lesions, neurological deficit also improved, CD4 T-lymphocytes increased above 200/μL, but blindness of the left eye persisted.

Conclusion: CT and MRI scans offered no clue as to Toxoplasma etiology of the brain and eye involvement in an HIV-positive patient, which was only confirmed by laboratory tests. Due to the delay in the diagnosis of toxoplasmosis, time from the epileptic seizure to treatment initiation was 16 days, which assumedly caused irreversible blindness in the patient.

Aim: The research aimed to identify and describe the main differences in the incidence of sexually transmitted infections in three regions of the Czech Republic.Methods: Descriptive cross-section study analyses data received from each institution that allowed access to the Registry of sexually transmitted illnesses of individual regions. Mainly three regions are being studied, yet the study considers only the data from the same time-period in all three regions (i. e., 2006–2013). To compare the development of the epidemiological situation, we considered the incidence rate (IR) and specific incidence rate for both age and age groups. Methods of descriptive statistics were implemented. For the analysis of statistically significant differences, we used ANOVA when p = 0.01, alternatively in some cases F-test before an unpaired T-test to test variability.Results: The highest incidence rate for all integrated STIs was reported in the Capital City of Prague region (CCP) – 398.3 cases per 100 thousand – whereas gonorrhoea appeared the most in CCP and Central Bohemia regions (CBR) and syphilis occurred the most in the Pilsen region (PLS). ANOVA identified statistically significant differences between all integrated regions within the frame of incidence of all STIs as a group of infections, and also as individual STIs. Of course, the T-test identified statistical differences in most cases only between CCP and the other two regions, even though these differences weren’t identified between CBR and PLR. Likewise, there were statistically important differences identified (by ANOVA for all three regions mutually) for the specific incidence rate for gender and the 15–64 age group category where the most cases were aggregated. In all three regions, there were more male cases (CCP 75%, PLR 58,7% and CBR 66%) with most of them being composed of Czechs (69.7–79.8 %). HIV coinfection was reported in 5.5% of cases in CCP, 3.9% in PLR and 5.3% in CBR.Conclusion: This study submits the results of data comparison from three Czech regions in the 2006–2013 time-period. It points out differences in the development of sexually transmitted infections in individual regions, mainly in men having sex with men and other risk groups. It also invokes the issue of the insufficient level of knowledge concerning sexually transmitted infections in the MSM subpopulation.

Introduction: Noroviruses, together with rotaviruses, are the most common cause of viral gastroenteritis in the Czech Republic (CR). The aim of this study was to analyse data on the incidence of norovirus gastroenteritis in the CR and thus to add to the body of knowledge about its significance.

Material and methods: A descriptive analysis was performed of the basic characteristics of norovirus gastroenteritis reported under ICD-10 code A08.1 to the Epidat or ISIN electronic infectious diseases information system between 2008 and 2020. On the basis of reports from five microbiological laboratories, weekly data on confirmed cases of norovirus infection from 2010-2020 were analysed. Databases of microbiology laboratories from across the Czech Republic were searched to determine the number of the laboratories where norovirus infections were diagnosed and the methods used for this purpose in 2008-2020.

Results: From 2008 to 2020, 33,575 cases of norovirus gastroenteritis were reported to the infectious diseases information systems, which equates to an annual incidence of 24.5/100,000 population, varying between years from 8.2 to 77.1/100,000. Men accounted for 40.2% of cases with an incidence of 20.1/100,000 compared to 28.8/100,000 recorded in women. Of the total of reported cases, 14,282 patients (42.5%) required hospital admission. Over the whole study period, 7,431 cases of norovirus gastroenteritis were recorded in children under 5 years of age. This age category accounted for 13.7-38.9% of the annual totals of reported cases. The incidences were 101.8/100,000 in children under 5 years of age, 40.1/100,000 in 5-14-year-olds, 12.7/100,000 in 15-64-year-olds, and 38.2/100,000 in the age group 65 years and over. Twenty-four deaths (case fatality rate of 0.07%) were reported as associated with norovirus gastroenteritis at the ages 42-94. In the age categories 15-64 years and 65 years and over, the case fatality rates were 0.02% and 0.24%, respectively. Over the study period, 274 epidemics occurred, during which 16,893 (50.3%) of the total of 33,575 cases were reported. In the epidemic outbreaks, 1,694 (10.0%) patients required hospital admission. The largest outbreak with 5,248 reported cases in 2015 was associated with contamination of the Prague water supply system. Norovirus infections were laboratory diagnosed year-round, peaking in the autumn and winter months. They are currently diagnosed by 81 laboratories in the Czech Republic, 90.1% of which use immunochromatographic tests.

Conclusion: The study confirmed the highest incidence of norovirus gastroenteritis among children under 5 years of age and the highest case fatality rate in the age group 65 years and over. Over half of the reported cases were outbreak associated. Most laboratories use immunochromatographic tests. The use of more sensitive laboratory methods would improve diagnosis.

Fungal infections are currently a serious health concern. Life-threatening conditions that occur mainly in immunocompromised patients are largely caused by representatives of the genus Candida. The most common causative agent is the yeast Candida albicans, but in recent years there has been a significant shift towards Candida glabrata and other so-called non-albicans Candida yeasts (e.g. Candida tropicalis or Candida parapsilosis). Invasive infections caused by the multidrug-resistant yeast Candida auris are associated with high mortality. There are several differences between C. glabrata and other causative agents of candidiasis in biological characteristics and virulence factors. The innate increased resistance to azoles along with the ability to rapidly acquire resistance to other groups of antifungal agents is a dangerous combination which makes it difficult to manage Candida infections. A better understanding of the virulence factors and mechanisms of resistance to antifungal agents can benefit the management of Candida infections. Equally important is the search for new target sites for antifungal therapy. The present work briefly summarizes the existing knowledge in this area.

Aim: The aim is to characterize in more detail the group of HIV-positive persons in the Czech Republic diagnosed with tuberculosis (TB) in 2000-2020.

Material and methods: Data sources were mainly the national online TB register (RTBC), which is part of the information system of the Public Health Service, and the national electronic register of HIV-positive persons (RHIV) maintained by the National Reference Laboratory for HIV/AIDS of the National Institute of Public Health.

Results: Of 3,763 TB cases reported to the RHIV since 1985 and 16,212 TB cases reported to the RTBC since 2000, 91 occurred in 88 HIV-positive persons (69 males and 22 females) between 2000 and 2020. Sixty-five (74%) of the 88 HIV-positive persons were foreign born. Twenty-six per cent of TB cases were screened for HIV. The mean age of patients with TB/HIV coinfection was 35 years. The largest number of coinfected persons (35 cases) were from the capital city of Prague. Pulmonary TB was detected in 84 cases. Ninety-two per cent of the TB cases were bacteriologically confirmed, and 10 cases were multidrug-resistant TB. At the time of TB diagnosis, the median CD4+ lymphocyte count was 91.5 cells per mm3 of blood. TB was the most common reason for HIV testing in the analysed cohort (23 cases). The most common mode of HIV transmission was sexual intercourse (heterosexual in 39 cases and homosexual in 13 cases). Treatment success at 12-month follow-up was only recorded in 32% of cases of culture-positive pulmonary TB in HIV-positive patients.

Conclusions: TB/HIV co-infection remains a serious health concern, especially in the foreign-born residents of the Czech Republic. Of foreign-born persons with TB, 42% were tested for HIV over the 21-year study period, with their percentage increasing over the years. Almost 6% of them tested HIV positive. The most relevant finding is that treatment success was only recorded for less than one third of HIV-positive persons with culture-positive pulmonary TB and that every fourth patient with TB/HIV died before or during TB treatment.