Ceskoslovenska epidemiologie, mikrobiologie, imunologie最新文献

The author analyzes the development and perspectives of epidemiology as a scientific discipline and as a component in the organization of the public health system. As a basis serve mainly evaluations and views of WHO on these problems.

The authors present a review of contemporary possibilities of septic shock in surgical patients. As mentioned by the authors, the most frequent cause of Gram-negative sepsis in surgery are intraabdominal inflammatory diseases or septic complications after planned surgery. Based on an experimental study on acute endotoxin shock in dogs and treatment with hydrocortisone, dopamine and antihypertensive drugs (mepamil and metazosine), the authors present some principles of the therapeutic procedure in endotoxin shock under clinical conditions. They emphasize in particular administration of antibodies against endotoxin and cytokines. In the clinical part they submit results of comprehensive therapy of intraabdominal sepsis in patients hospitalized at the intensive care unit of the Surgical Clinic at the Third Medical Faculty in Prague. They give an account of the principles of peroperative and postoperative treatment within the framework of differentiated care. During the postoperative period it is important to ensure prevention and treatment of septic complications such as septic shock and the syndrome of multiorgan systemic failure as well as rational antimicrobial therapy, immunotherapy and adequate nutrition. The authors emphasize that it is essential that specific antibodies are available and indications of their administration must be defined. The expected effect of immunotherapy is limited by the period of administration in relation to early stages of sepsis.

The authors describe the isolation of a rare serovar Plesiomonas shigelloides from a patient with diarrhoea. The isolated strain belongs according to a combined Japanese-Czechoslovak antigenic scheme to serovar 024 H"o". The interesting finding draws attention to the possibility of routine departments to contribute to investigations of the incidence, importance and antigenic structure of this bacterial species.

The author evaluated conditions necessary for the development of the most common intestinal helminths in swimming pools and emphasizes provisions which prevent their development. The author recommends helminthological examinations only in indicated cases.

Endotoxin shock is not only the reflexion of Gram-negative focal infection but also the consequence of dysfunction of the intestinal mucous barrier and a decline of the detoxication capacity, in particular of the hepatic mesenchymal phagocytic system during a critical state. Cytokines and the primary LPS complex and its lipid A resp. are of basic importance. They start the release of a large amount of TNF alpha, IL-1, IL-6, IL-8 and other cascades. Acute shock is controlled nowadays more frequently than in the past, however, there is a high risk of a very adverse reaction of remote organs, which is very adverse from the prognostic aspect. A series of laboratory markers has a greater validity than the clinical picture alone. For screening derived markers are used not primary markers. Despite this they provide adequate information. Prophylaxis and treatment include selective bacterial decontamination, or active or passive immunization (PSAEVA, hyperimmune sera), minidoses of dopamine in a continuous infusion, early enteral nutritional intervention, in particular enteral nutrition containing glutamine. Monoclonal and polyclonal antibodies against the LPS complex and cytokines are tested, blocking their receptors or possibly early plasmapheresis. Permanent pillars of therapeutic tactics are still a radical and early elimination of possible infectious foci and targeted administration of antibiotics and maintenance of the perfusion pressure and adequate oxygenation.

The authors give an account of hybridization methods, in particular DNA probes and the polymerase chain reaction (PCR) and their application in microbiological diagnosis. They deal with the principle of the two methods and their applications in the diagnosis not only of genera and species but also different factors of pathogenicity and virulence. The authors mention the advantages and disadvantages of radioactively and non-radioactively labelled probes such as PCR. They draw attention to the perspective application of these methods in research and diagnostic laboratories.

The authors investigated the antibody response against beta-lactam antibiotics (penicillins, cephalosporins, monolactams, carbapenes) in conjugation with allergic reactions after penicillin administration. The results revealed a high percentage of positive antibody responses against penicillin and high percentage of crossed immunological reactivity between penicillin and the other investigated preparations.

The author describes techniques of laboratory processing of different biological materials used for detection of potentially pathogenic micromycetes which are involved in the aetiology of secondary mycoses. The author describes in detail methods for the quantitative assessment of yeasts in urine and sputum.

A group of 75 strains of Neisseria meningitidis isolated from patients with meningococcal meningitis in the Czech Republic during 1980-1988 was characterized by assessment of serogroups, serotypes, serosubtypes and genotypes. Twelve strains belonged into serogroup A, 27 into serogroup B and 36 into serogroup C. The most frequently found serotype was 4, subserotype P1.2. The authors identified 48 different enzyme genotypes among which four genetically related groups were assessed. Strains of Neisseria meningitidis of the same genotype were found more frequently during the period of 1980-1984, when a rise of meningococcal meningitis in the Czech Republic was recorded. During this period 73% of the strains belonged into three genetically related groups, while during the subsequent period (1985-1988) these genetically related groups comprised only 47% of the strains. Only one strain of Neisseria meningitidis (878/85) represented a genetic clone ET-5 complex responsible for an epidemic of meningococcal meningitis in western European countries from the mid-seventies.

The authors compared the results of two methods used for the quantitative assessment of C-reactive protein: the method of radial immunodiffusion and the microturbidimetric method. The testing was based on examination of 68 sera from patients. The samples comprised sera with a CRP concentration under 230 mg/l. There was a statistically significant correlation between the results of the two compared methods (r = 0.949, p = 0.0001).