Ceskoslovenska epidemiologie, mikrobiologie, imunologie最新文献

Sepsis is due to its lethality, which varies round 25%, one of the major problems of contemporary clinical medicine. Classical therapeutic approaches, i.e. chemotherapy, surgical elimination of foci and intensive therapy focused on maintenance of vital functions have obviously reached the limit of effectiveness beyond which they are unable to advance any further. Therefore great efforts are devoted to research into pathogenetic mechanisms involved in sepsis with the aim to use their effect to improve therapeutic results. In the submitted paper the authors analyze the definition of sepsis, explain the concept of the syndrome of systemic inflammatory response and summarize the contemporary state of knowledge of the pathogenesis. A review of structures and mechanisms involved in the genesis and development of sepsis (complement, factor XII, macrophage, endothelial cell, polymorphonuclear leucocyte, thrombocyte etc.) is supplemented by a list of substances which act as mediators of inflammations. The conclusions for practice summarize contemporary therapeutic possibilities, i.e. classical means as well as more recent approaches (colony stimulating factors, haemodiafiltration, antithrombin III, monoclonal antibody against endotoxin). The authors review briefly therapeutic means which are developed at present and which should make it possible to interfere actively with the pathogenesis of the disease.

Examinations of 1,998 ticks Ixodes ricinus in the district of Olomouc revealed 182 cases of borrelia, i.e. in 9.1% ticks. Prevalence in males is 10.7%, in females 12.8% and in nymphs 7.0%. A certain coincidence was observed between mosquito incidence, in particular during the first half of the year, and borrelia prevalence in ticks in the course of the following year, with prevalence variations manifested in tick imagos only. A hypothesis is formulated that mosquitos feeding on larger animals, who are often attacked by nymphs of I. ricinus ticks, can increase the infection rate in the hosts by borrelia transmission and thus participate in the increase of tick imago prevalence during subsequent years.

The typical clinical picture and mycological and histological basis of chromomycosis is compared with the clinical course, which is encountered more often nowadays. It refers also to the affection of the vascular, respiratory, lymphatic system, the brain and the dissemination in compromised patients. For this reason chromomycosis should rank among opportunistic mycoses. Chromohyphomycosis characterized by skin nodules occurs very rarely. Subcutaneous abscesses also called phaeomycotic cysts, are more frequent especially after corticoid and immunosuppressive therapy. Among three Czechoslovak cases of chromomycosis, the case in Pilsen can be evaluated as uncommon. It was caused by Phialophora pedrosoi and passed as a skin form of chromomycosis. The lesion developed on the right forefinger of a patient who never visited tropical countries. She never was seriously ill, never treated with antibiotics, chemotherapeutics, or corticosteroids. The histological examination of the excision revealed a granuloma with histiocytes and many giant cells phagocytizing typical spherical brown microorganisms. The patient was cured by KI, intraiodine and X-ray therapy.

Due to world-wide use of 3rd generation cephalosporins and new beta-lactam antibiotics (imipenem, aztreonam), serious problems emerge caused by the appearance and spread of bacterial strains resistant also to these drugs. While the resistance to ceftazidime, cefotaxime and other "stable" cephalosporins has a transferable character and is plasmid-coded, the resistance to imipenem is transmissible only by bacteriophages. New enzymes in resistant bacteria bind specifically with the metoxyimino moiety of the molecule of these drugs. It is assumed that cephalosporins without the metoxyimino-group (4th generation) and new variants of imipenem (1-methyl-carbapenems, like meropenem and biapenem) will dominate therapy with betalactam antibiotics in the future.

The author gives an account of another 77 species of micromycetes and some varieties of micromycetes which supplement the alphabetical list of 163 fungi which infect man, prepared by Otcenásek and Dvorák in 1985. Problems of medical mycology are discussed.

The author investigated the effect of N,N'-bis(decyldimethyl)-1,6-hexane diammonium dibromide on vegetative cells and spores of Clostridium perfringens type A. The investigated substance caused in concentrations of 1.0-4.0 micrograms.ml-1 escape of K+ from clostridia cells. At higher concentrations-2.0-16.0 micrograms.ml-1-high molecular components of the cytoplasmic material escaped. The author investigated the effect of the mentioned substance on germination of spores of Clostridium perfringens type A, using concentrations of 10, 20 and 40 micrograms.ml-1. The lower concentration of the substance (10 micrograms.ml-1) did not inhibit the onset of germination of spores of the tested strain, however, the post-germination development was retarded, as compared with controls. Germination of spores of Cl. perfringens type A in the presence of higher concentrations of the compound (20 and 40 micrograms.ml-1) was affected already in the initial stage. The germinating spores were most sensitive to the action of the substance when it was added after 60 and 120 min. following activation of spores for germination. The tested substance reduced the thermal resistance of Cl. perfringens type A spores.

The authors describe the finding of Actinomyces viscosus in pus from a subdural empyema in a child patient. When searching for the probable primary source of this uncommon infection of the central nervous system the authors identified by cultivation the same bacterial strain in a periapical dental granuloma. Bacterial diagnosis and radical surgical and antimicrobial therapy led to normalization of a clinical condition with an initially unfavourable prognosis.

The authors characterize individual tests of the STAPHYtest Lachema and some other selected tests by calculating their discriminating capacity on 16 types of staphylococci which are most frequently isolated in clinical microbiological laboratories. Individual tests are characterized by the separating value, as described by Gyllenberg and Rypka, the variation index of Sneath and the consistency index. As regards discrimination, tests involving fermentation of trehalose, sucrose and glycerol are of no value. Conversely more important tests are lacking--sorbitol, melisitose, ONPG, DNA-ase, arginine.