Epidemiologie Mikrobiologie Imunologie最新文献

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.

Study aim: To determine the genetic diversity of human isolates of Listeria monocytogenes obtained in 2016-2020 from clinical laboratories in various locations of the Czech Republic with a focus on their possible epidemic links and virulence using whole genome sequencing data.

Methods: A total of 102 human L. monocytogenes isolates, serotyped by slide agglutination in combination with multiplex PCR serotyping, were used in this study. Whole genome sequencing was performed retrospectively, and based on the obtained data, the clonal relatedness of the tested strains and the presence of virulence genes were assessed using the Ridom SeqSphere+ software.

Results: In 2016-2020, 102 human isolates of L. monocytogenes were characterized, which represented 65% of all cases of listeriosis reported to the ISIN/EPIDAT systems in the Czech Republic in the monitored period. Serotype 1/2a (57%) was dominant, followed by serotype 4b (30%). Strains of serotype 1/2b (12%) and 1/2c (1%) were rarely detected. Based on the analysis of whole genome sequencing data, the strains were assigned to 26 clonal complexes and 27 sequence types. The cgMLST (core genome Multi-Locus Sequence Typing) analysis revealed four clusters of more than three strains, showing high relatedness (differences up to 10 alleles) with a possible epidemic link. The presence of all key virulence genes was confirmed in all strains. Only three strains (of serotypes 1/2a, 1/2b, and 1/2c) carried a point mutation in the inlA gene responsible for the expression of truncated internalin A protein, which is involved in the mechanism of intestinal barrier crossing by L. monocytogenes.

Conclusion: Molecular epidemiology based on whole genome sequencing is an effective tool to study the population structure of L. monocytogenes strains. This study found high heterogeneity of human L. monocytogenes strains, especially for serotype 1/2a, dominant in the Czech Republic. Several clusters with a possible epidemic link have been identified, and their occurrence will be further monitored.

Malaria is one of the worlds most important infectious diseases, occurring in many tropical and subtropical countries. The causative agent is a parasitic protozoan of the genus Plasmodium, transmitted to humans by infected mosquitoes. More than 200 million people get malaria every year worldwide, and hundreds of thousands of them, mostly children under 5 years of age, die of it. Thanks to prevention programmes implemented by various organisations headed by the World Health Organisation (WHO) with the aim of eliminating malaria, cases have been declining in recent years. However, particularly in African countries, malaria continues to be a health and economic issue.

Aim: An analysis is presented of epidemiological and molecular data from invasive meningococcal disease (IMD) surveillance in the Czech Republic (CR) for 1993-2020, comparing trends in four seven-year periods: 1993-1999, 2000-2006, 2007-2013, and 2014-2020.

Material and methods: IMD surveillance data are generated by linking National Reference Laboratory for Meningococcal Diseases data and epidemiological data routinely reported to the infectious diseases information systems, with duplicate data removal. Whole genome sequencing (WGS) was used for analysis of selected isolates from IMD cases. In this study, WGS data are analysed on 323 isolates recovered from IMD cases in the Czech Republic between 1993-2020.

Results: Over the entire study period 1993-2020, 2,674 cases were recorded in the IMD surveillance programme, of which 272 were fatal. In the first seven-year period, the highest incidence rate of 2.2/100,000 population was reported in 1995, a gradual decline from 0.8 to 0.6/100,000 was observed in the third period, and in the last period, this decline continued until 2020, achieving a low of 0.2/100,000. In all four study periods, the age group 0-11 months was the most affected, followed by 1-4-year-olds and 15-19-year-olds. Serogroup B caused the highest number of cases (43.6%), followed by serogroups C (34.9%), Y (1.8%), and W (1.5%). Serogroup X was only found in three cases. The overall case fatality rate in the entire study period was 10.2%, with no decline seen in the four periods. The highest case fatality rate was associated with serogroup Y (14.6%), followed by serogroups W (12.5%), C (12.0%), and B (8.1%). In terms of age, the highest case fatality rate was observed in people aged 65+ (24.7%). The WGS data for 323 IMD isolates from 1993-2020 showed the highest representation of eight clonal complexes: cc11, cc44/41, cc32, cc267, cc23, cc18, cc35, and cc865. Isolates of serogroup C, cc11, from the last study period form two genetically distinct populations with distinct phenotypes that are genetically distant from the lineage of cc11 isolates from the first two periods. The study population included a unique Czech subpopulation of serogroup W isolates (ST-3342, cc865), recorded only in the last two periods (2007-2020), whose position in the phylogenetic network supports the theory that the serogroup W population in the Czech Republic originated from serogroup B isolates as a result of serogroup switch (capsule switch). Clonal complexes cc41/44, cc32, cc267, cc18, and cc35 are predominantly composed of serogroup B isolates, while cc23 includes exclusively serogroup Y isolates.

Conclusions: The analysis of surveillance data over a 28-year period confirms that the vaccination strategy currently used in the Czech Republic, i.e., vaccination of young children and adolescents with a combination of MenB vaccine and quadrivalent conjugate ACWY vaccine,

Aim: The aim of study was to evaluate completeness and estimate sensitivity of the measles surveillance using the new electronic version of the national notification system of infectious diseases (ISIN) in order to assess its performance.

Material and methods: The completeness of measles reporting in the ISIN for demographic characteristics (week and region of reporting, age and gender), date of onset, complications, hospitalisations, vaccination status, used laboratory methods and country of import from January 2018 to June 2019 was assessed. The register from National Reference Laboratory (NRL) and the ISIN were compared using the capture-recapture method (CRM). Cases were matched using unique personal identifier. The total number of measles cases in the population was assessed using the Chapmans formula. Sensitivity of reporting was calculated by dividing the number of reported cases by the CRM estimated true number of cases.

Results: In the ISIN, 765 measles cases were registered within specified time period. For many variables 100% completeness was found. The data were missing mainly for vaccination status (20%), serology results (55%) and used laboratory methods (8%). The NRL confirmed 653 patient samples in respected period. Within both registries (ISIN and NRL) the total 612 cases were matched. Estimated real number of measles cases using the CRM was 816 (95% CI: 809-823) compared to 806 reported cases. The estimated surveillance system sensitivity was 98.8%. Five percent (n = 41) of cases tested positively in the NRL were not reported to the ISIN.

Conclusions: We found high level of reported measles data completeness in the ISIN for most variables. Estimated real and reported number of cases was in a good correlation and calculated sensitivity of the ISIN was on very high level. Though, the data sources used in the study were not independent on each other, therefore results may not be fully accurate. The technical changes (more mandatory fields and more logical syntax to check data) in the ISIN to improve data completeness are being recommended. Data providers should report all measles cases to the ISIN with maximum precision in entering individual variables and investigating laboratories should send samples for confirmation to the NRL in required cases.

Background: We estimated what risk factors affect hospitalisation for confirmed pertussis cases among infants (child up to 1 year) in the Czech Republic based on data from the questionnaire-based enhanced surveillance system (ESS) in years 2015, 2017 and 2019.

Methods: Retrospective cohort study was conducted in which we assessed demographic, clinical data, vaccination status and risk/protective factors. Vaccination status was extracted from the electronic nationwide notification system (NNS). We performed descriptive, univariable and multivariable analysis using risk ratio (RR) and logistic regression with odds ratio (OR).

Results: A total of 104 confirmed cases (27, 13, 64) were reported in the ESS during 2015, 2017 and 2019. Most cases were in age group 1 month (24), more males (57). Fifteen cases were vaccinated and 89 unvaccinated. Of 88 hospitalised cases, 31 cases reported stay in Intensive Care Unit (ICU). The median length of hospitalisation was 8 days. Although the variable vaccinated in infants was statistically significant in a univariable analysis for outcome hospitalisation, RR 0.76 (95% CI 0.53-1.10), it was not in multivariable. Hospitalisation was strongly associated with the younger age group of 0-3 months adjusted by a smoking family member in a household (OR = 9.72; 95% CI: 2.97-31.81). Stay in ICU was strongly correlated with the younger age group of 0-3 months (OR = 5.07; 95% CI: 1.44-17.87) and with a contact with confirmed or probable pertussis (OR = 7.05; 95% CI: 1.36-36.52).

Conclusions: Our study demonstrated younger age and contact with other pertussis case as risk factors for hospitalisation of infants with pertussis. It is necessary to consider adolescent and adult boosters, including vaccination during pregnancy. We suggest integrating the variables from the enhanced surveillance system into the nationwide notification system, in order to simplify the data reporting and evaluation. Further studies are needed to evaluate the ESS and to monitor the vaccination of pregnant women against pertussis.