What we know and still do not know about tick-borne encephalitis?

Tick-borne encephalitis (TBE) is a febrile illness caused by tick-borne encephalitis virus (TBEV), frequently manifesting as inflammation of the central nervous system. TBEV is a typical arbovirus, i.e., belongs to a group of viruses transmitted by blood-sucking arthropods. Taxonomically, TBEV is a member of the genus Flavivirus, family Flaviviridae. The disease is endemic in North Eurasia, from western Europe to East Asia. The virus occurs in natural foci of the disease all over Czechia, where it is transmitted predominantly by the castor bean tick (Ixodes ricinus). This infection has a potential to cause significant long-term disability affecting the quality of the patients life. Vaccine is available; however, vaccination coverage in Czechia is still low (around 30% of the total population). Lately, attention has been focused on new possibilities for early diagnosis and specific treatment, which so far has only been symptomatic or empirical.

[Endoprosthesis Infections - Guidelines for Antibiotic Therapy Common Guidelines of the Czech Society for Orthopaedics and Traumatology and the Society for Infectious Diseases of the Czech Medical Association of J. E. Purkyne]. / Infekce endoprotéz ­ doporucení antibiotické lécby Spolecné doporucení Ceské spolecnosti pro ortopedii a traumatologii a Spolecnosti infekcního lékarství Ceské lékarské spolecnosti J. E. Purkyne.

PURPOSE OF THE STUDY This study aims to articulate regional guidelines for curative and suppressive antibiotic therapy of total joint replacement infections. MATERIAL AND METHODS When developing the standard, used as source materials were the published foreign guidelines for antibiotic therapy of prosthetic joint infections, the analysis of resistance of bacterial strains conducted in the Hospital in Ceské Budejovice, a.s. and the assessment of strain resistance for the Czech Republic published by the European Antimicrobial Resistance Surveillance Network (EARS-Net). Considered was also the availability of individual antibiotics in the Czech Republic and restricted prescription according to the Summary of Product Characteristics as specified in the State Institute for Drug Control marketing authorisation. The expert group composed of orthopaedists, microbiologists and infectious disease specialists elaborated the basic antibiotic guideline for choosing an appropriate antibiotic/antifungal drug based on the usual susceptibility, its dose and dosage interval for initial and continuation therapy. The comments of individual specialists were gradually incorporated therein and in case of doubts majority rule was applied. The drafted document was sent for peer reviews to clinical orthopaedic, infectious disease and microbiological centres, whose comments were also incorporated and the finalised document was submitted for evaluation to specialised medical societies. RESULTS The outcome is the submitted guideline for antibiotic curative and suppressive therapy suitable for managing the prosthetic joint infections, which was approved by the committee of the Czech Society for Orthopaedics and Traumatology andthe Society for Infectious Diseases of the Czech Medical Association of J. E. Purkyne. DISCUSION Curative therapy of total joint replacement infections consists primarily in surgical treatment and has to be accompanied by adequate antibiotic therapy administered initially intravenously and later orally over a sufficient period of time. Bearing in mind the wide spectrum of pathogens that can cause infections of a joint replacement and their capacity to form a biofilm on foreign materials, the correct choice of an antibiotic, its dose and dosage interval are essential for successful treatment. Such standard should respect regional availability of antibiotics, regional pathogen resistance/susceptibility and ensure the achievement of sufficiently high concentrations at the requested location including anti-biofilm activity. CONCLUSIONS The submitted guideline is not the only treatment option for joint total replacement infections, but it makes the decisionmaking easier when treating these complications in the form of infections. The final choice of an antibiotic, its dose and duration of therapy shall be based on a critical assessment of results of microbiological (blood culture and molecular genetic) tests and reflect the patient s clinical condition. Since these are multidisciplinary issues, we consider useful for this guideline to be commented upon and approved by the committee of both the Society for Orthopaedics and Infectious Diseases so that it can become the starting point for treatment. Key words: total joint replacement infection, TEP, ATB, antibiotic therapy, consensus meeting, guideline.

Quantitative determination of IgM antibodies reduces the pitfalls in the serodiagnosis of tick-borne encephalitis.

BACKGROUND: Tick-borne encephalitis (TBE) is the most important arbovirus disease in parts of Europe and Asia. Its laboratory diagnosis depends on the detection of specific IgM antibodies which can be impeded by (1) long-time persistence of IgM antibodies after infection, (2) vaccine-induced IgM antibodies, and (3) cross-reactive IgM antibodies from other flavivirus infections. OBJECTIVES: To assess the extent of interference factors in the serodiagnosis of TBE that might lead to the false positive assignment of a recent infection. STUDY DESIGN: We quantified TBE virus-specific IgM and IgG antibodies in sera collected at different time points from cohorts of (1) 61 TBE patients, (2) 131 TBE vaccinees, and (3) 42 patients with recent dengue or West Nile virus infections. RESULTS: All of the TBE patients were IgM- and IgG-positive upon hospitalization and 87% of acute TBE sera had IgM antibody titers of >500 Arbitrary Units (AU). These titers rapidly declined and only 16% of TBE patients had low IgM titers ≥9 months after infection. Vaccine-induced as well as flavivirus cross-reactive IgM antibodies were rarely detectable and of low titer. CONCLUSIONS: Most of the potential problems of TBE serodiagnosis can be resolved by the quantification of IgM antibodies in a single serum sample taken upon hospitalization. High IgM values (>500 AU in our assay) are indicative of a recent infection. Lower IgM values, however, may require the analysis of a follow-up sample and/or a specific neutralization assay to exclude the possibilities of IgM persistence, vaccine-induced IgM antibodies or heterologous flavivirus infections.

[Epidemiologic monitoring of tick-borne encephalitis in Rimov in Southern Bohemia]. / Epidemiologické sledování klíst'ové encefalitidy v jizních Cechách. Lokalita Rímov. Pomer manifestních a inaparentních forem infekce, stanovenî proitilátkové odezvy ve sledovaném souborn. Snaha zvýsit intervencí stupen imunity mimorádným ockováním u osob s nízkými ci negativními titry v lokalite. Rímov v období prelomu roku 2001/2002.

Southern Bohemia is one of the extensive natural foci of tick-borne encephalitis (TE) in the Czech Republic. Some professionals hold the view that people living in the focus of infection acquire naturally herd immunity and are the protected against the infection and thus it is not necessary to vaccinate them against TE. Several serious cases of the disease in temporal sequence in Rímov in the district of Ceské Budejovice led the authors to examine more closely the problem of TE in this locality. Available epidemiological data were analyzed. A group of subjects with permanent residence in the community was assembled who were interested to participate in the trial. In these serological examinations were made to assess antibodies against TE. Analysis of the assembled data proved that during permanent residence in Rímov 6.07% of the investigated group during their life in Rímov developed the manifest form of TE, 9.64% developed the inapparent form and 15% subjects had antibodies after previous vaccination. The ratio of manifest and inapparent cases is 6.07:9.64, i.e. roughly 2:3. The total seroprevalence after the disease (manifest and inapparent) is 16%. Persons with a negative result of the examination were offered vaccination. The vaccination rate increased due to the authors' intervention from 15% to 65% in the given community.

[Changes in Roughness of Exposed Head of POLDI Femoral Component.]. / Zmeny drsnosti exponované hlavice cementované totální endoprotézy kycelního kloubu POLDI.

The authors have examined the roughness of the heads of four exposed all-metal cemented femoral components of Poldi type using Talysurf 6 device. The results achieved were compared with the roughness of the not yet used head of Poldi femoral component. Both in the exposed and not used heads the Ra factor lower than the value reported in production documentation of the manufacturer. Even in a longterm exposition (17 years) there occurred no changes in the roughness of the metal head of the femoral component. Therefore it is possible in revision surgeries due to aseptic loosening of the acetabular component, to replace only the cup and leave the original stem in place. Key words: THR, femoral component, surface roughness.

A randomised comparison of meropenem with cefotaxime or ceftriaxone for the treatment of bacterial meningitis in adults. Meropenem Meningitis Study Group.

Third-generation cephalosporins are presently the agents of choice for the empirical antimicrobial therapy of bacterial meningitis. However, a number of factors associated with these agents, namely the development of resistance by pneumococci, limited activity against some Enterobacteriaceae and Pseudomonas spp., and the possible adverse effects of their bacteriolytic mode of action, indicate that newer classes of antimicrobial agents be evaluated for the treatment of bacterial meningitis. Meropenem is a carbapenem antibiotic which is highly active against the major bacterial pathogens causing meningitis, and penetrates well into the cerebrospinal fluid. Two prospective randomised studies in 56 adult bacterial meningitis patients have compared meropenem 40 mg/kg 8-hourly, up to a maximum of 6 g/day (n = 28) with cephalosporin treatment, i.e. cefotaxime (n = 17) or ceftriaxone (n = 11). Patients were assessed by neurological examination, Glasgow Coma Score and Herson-Todd score. Clinical cure was observed in all 23 evaluable patients treated with meropenem (100%) and with 17 of the 22 evaluable cephalosporin-treated patients (77%). All pre-treatment isolates were eradicated except one isolate of Staphylococcus aureus in a cefotaxime-treated patient. Neurological sequelae were noted in three meropenem and four cephalosporin-treated patients. No patients in either treatment group experienced seizures after the start of therapy. This was despite the fact that a patient in each group had experienced seizures before therapy, several had underlying CNS disorders, and that doses of 6 g/day of meropenem were given. Hearing impairment was recorded in 11 meropenem and nine cephalosporin treated patients. Three patients in the meropenem group and one in the cephalosporin group died during treatment for reasons unrelated to study therapy. Overall, the results of this study indicate that meropenem is an effective and well-tolerated antibiotic for the treatment of bacterial meningitis in adults.

[Surgery of pseudointraplical ovarian tumor]. / Zur operation der pseudointraplikalen Ovarialgeschwulst.

Ovarian tumors are situated retroplical, not within both layers of pica lata. The operation of such pseudointraplical tumors is without danger if these anatomical facts are noticed.

[Spiral cesarean section--hysterography]. / Sectio caesarea spiralis--Hysterographie.

Spiral caesarean section is a new technique to open the uterus. The following benefits are claimed for the new method, with reference being made to experience obtained separately at two hospitals:--1. The effect of uterus opening to expose the head of the foetus was higher by something between 19 and 38 per cent, as compared to all other methods. 2. Delivery was possible even from mid-pelvic level, and it was also possible at any stage of labour from breech and transverse positions. 3. Incisions would not further open towards the edge of the uterus, and larger blood loss was thus prevented. 4. The uterus scar was solid, as confirmed by hysterography in this report.