[Tick-borne encephalitis in the East Bohemia Region and its microbiological diagnostic pitfalls]. / Klíst'ová encefalitida ve vychodoceském regionu a úskalí její mikrobiologické diagnostiky.

AIM OF THE STUDY: The analysis of cases of tick-borne encephalitis (TBE) laboratory diagnosed at the Department of Virology of the Institute of Clinical Microbiology of the University Hospital in Hradec Králové in 2003-2006 and comparison of the data from 2003-2006, 1999-2002 and 1995-1998. Another objective was to compare two routinely used ELISA (enzyme-linked immunosorbent assay) diagnostic kits for TBE. MATERIAL AND METHODS: The samples from 3284 patients tested by the Department of Virology of the University Hospital in Hradec Králové in 2003-2006 were analyzed. The detection of the specific IgM and IgG antibodies in serum and cerebrospinal fluid specimens was performed using two ELISA diagnostic kits (Euroimmun, Germany, and Test-Line Ltd, Clinical Diagnostics, Czech Republic). Non-specific reactivity of IgM antibodies was only analyzed in 2004-2006. RESULTS: In 2003-2006, TBE was diagnosed in 163 patients of the University Hospital in Hradec Králové aged from 3.5 months to 80 years. The number was by 48 cases (29%) higher than that in 1995-1998 and by 36 cases (22%) higher than that in 1999-2002. TBE was confirmed in 94 males (57.7%) and 69 females (42.3%). More than half of the patients were aged above 41 years (94/163, i.e., 57.6 %) and 60 patients (37 %) were older than 51 years. A biphasic course of infection was observed in 93/136 cases (68.4%). As many as 101/136 patients (74 %) had a history of a tick bite, one patient reported the consumption of non-pasteurized milk. Thirty-eight (1.4 %) specimens showed non-specific reactivity of IgM antibodies. None of the cases showed cerebrospinal fluid reactivity in the absence of serum reactivity. CONCLUSIONS: Increase in the diagnosed TBE cases was reported in 2003-2006 in the East Bohemia Region. It was due mainly to more severe clinical forms of TBE that were more frequent than the milder ones. The distribution of the confirmed TBE cases remained unchanged in terms of age and sex, but the seasonal peak moved from summer to autumn. ELISA proved suitable for use in the routine diagnosis of TBE. Both of the tested commercial kits are of good quality. Nevertheless, in view of possible non-specific reactivity of IgM antibodies, IgG antibodies need to be tested in both the first acute serum specimen and paired sera. The detection of antibodies in cerebrospinal fluid is unlikely to be of diagnostic benefit for TBE. Close cooperation between the attending physician and clinical microbiologist is crucial.

[Toxoplasmic encephalitis in an HIV patient]. / Toxoplazmová encefalitida u pacienta s HIV infekcí.

Toxoplasmic encephalitis is considered one of the most frequent causes of death in HIV-positive patients. The article presents a case of a 40-year-old HIV-positive male hospitalized for surgical treatment of localized brain tumour verified by CT and MRI. Histopathologically, toxoplasmic aetiology was confirmed. Briefly, tissue toxoplasmosis represents a high risk among HIV-positive patients. Therefore, this disease must be considered in differential diagnosis of localized brain masses in HIV-positive patients.

[Difficulties in laboratory diagnosis of cerebral toxoplasmosis]. / Uskalí laboratorní diagnostiky mozkové toxoplazmózy.

Toxoplasmosis is the most wide-spread parasitic disease in the Czech Republic. According to the results of serological studies, about 25-50% of its population come in contact with this protozoan. A serious form of the disease may develop in severely immunocompromised patients. In these patients, problems with diagnosing toxoplasmosis may occur, especially in the case of its rare but serious cerebral form. The aim of the case report is to present potential difficulties in the diagnosis of cerebral toxoplasmosis.

[Amniotic fluid heat shock protein 70 concentration in preterm premature rupture of membranes]. / Heat shock protein 70 v plodové vode u pacientek s predcasným odtokem plodové vody.

OBJECTIVE: The purpose of this study was to determinate the changes of amniotic fluid HSP 70 concentrations in patiens with preterm premature rupture of the membranes, and in the presence of intraamniotic infection and histological changes of inflammations. DESIGN: Prospective study. SETTING: Department of Obstetrics and Gynecology Medical Faculty Charles University Hradec Králové. METHODS: We studied 30 women between 24 and 36 weeks of gestation with preterm premature rupture of the membranes. Samples of amniotic fluid were collected by transabdominal amniocentesis. These patients were divided into 2 groups. In group 1 were patiens with intraamniotic infection. In group 2 were patiens without intraamniotic infection. Among 76% (35/30) patients placenta were collected and assessed for presence or absence acute inflammatory lesions. HSP70 concentration in amniotic fluid were determined using a sensitive and specific diagnostic kit Hsp 70- ELISA kit manufactered Assay Desings, USA. RESULTS: There was no significant difference in the median amniotic fluid HSP70 concentration between patients with preterm rupture of the membranes with IAI and without IAI (patients with IAI: median 5.12 ng/ml, range 3.01-90.37 ng/ml vs. patients without IAI: median 4.68 ng/ml, range 0.58-84.28 ng/ml; p = 0.56). There was no significant difference in the median amniotic fluid HSP70 concentration between patients with preterm rupture of the membranes with presence and absence histological of acute inflammatory lesions in the placenta and membranes (patients with presence: median 6.97 ng/ml, range 2.61-90.37 ng/ml vs. patients with absence: median 4.63 ng/ml, range 0.58-84.28 ng/ml; p = 0.68). CONCLUSION: Intraamniotic levels HSP70 were not associated with intraamniotic infection and acute inflammatory lessions in the placenta and membranes.

[Amniotic fluid interleukin 6 levels in preterm premature rupture of membranes]. / Interleukin 6 v plodové vode pacientek s predcasným odtokem plodové vody.

OBJECTIVE: The purpose of this study was to determinate the changes of amniotic fluid interleukin 6 (IL-6) concentrations in patients with preterm premature rupture of the membranes (PPROM), and in the presence of microbial invasion of the amniotic cavity (MIAC) and histological chorioamnionitis (HCA). The aim was to examine amniotic fluid IL-6 in relation to MIAC and HCA. DESIGN: Prospective study. SETTING: Department of Obstetrics and Gynecology Medical Faculty Charles University Hradec Králové. METHODS: We studied 37 women between 24 and 36 weeks of gestation with PPROM. Samples of amniotic fluid were collected by transabdominal amniocentesis. Polymerase chain reaction for the genital mycoplasmas and culture for aerobic and anaerobic bacteria were performed. Twenty-eight of 37 patients placentas were collected and assessed for presence or absence HCA. IL-6 concentration in amniotic fluid were determined using a sensitive and specific diagnostic kit Human IL-6 Quantikine ELISA manufactured R&D Systems, USA. RESULTS: There was significant difference in the median amniotic fluid IL-6 concentration between patients with preterm rupture of the membranes with and without MIAC and HCA (patients with MIAC and HCA: median 915 pg/ml, range 651-1854 pg/ml vs. patients without MIAC and HCA: median 780 pg/ml, range 184-1059 pg/ml; p=0.047). There was no significant difference in the median amniotic fluid IL-6 concentration between patients with preterm rupture of the membranes with and without MIAC (patients with MIAC: median 915 pg/ml, range 195-1854 pg/ml vs. patients without MIAC: median 792 pg/ml, range 184-1993 pg/ml; p=0.53). There was no significant difference in the median amniotic fluid IL-6 concentration between patients with preterm rupture of the membranes with and without HCA (patients with HCA: median 829 pg/ml, range 195-1992 pg/ml vs. patients without HCA: median 768 pg/ml, range 184-1890 pg/ml; p = 0.31). CONCLUSION: Amniotic fluid IL-6 concentrations patients with PPROM with presence HCA and MIAC were significantly higher than IL-6 concentration patients without HCA and MIAC.

[Recurrent vulvovaginal candidiasis--possibility of its treatment]. / Rekurentní vulvovaginální kandidóza--soucasný stav problematiky a lécebné moznosti.

OBJECTIVE: A review of recurrent vulvovaginal candidiasis and the possibility of its treatment. SUBJECT: Original study. SETTING: Department of Obstetrics and Gynaecology, Medical Faculty Hradec Králové, Charles University, Prague. Department of Clinical Microbiology, Medical Faculty Hradec Králové, Charles University, Prague. Department of Biological and Medical Sciences, Faculty of Pharmacy Hradec Králové, Charles University, Prague. Department of Clinical Imunology and Allergology, Medical Faculty Hradec Králové, Charles University, Prague. Department of Psychiatry, Medical Faculty Olomouc, Palacky University, Olomouc. METHODS: Analysis and discussion focused especially on our results and experience in a long time followup of patients with confirmed recurrent vulvovaginal candidiasis. CONCLUSION: Owing to the multifactorial character of etiopathogenesis, the management of recurrent vulvovaginal candidiasis would be taken into consideration the complexity of the disease, not only the treatment of individual episodes with antimycotics.

[Multidisciplinary approach to the management of vulvovaginal discomfort]. / Problematika vulvovaginálního dyskomfortu z hlediska mezioborové spolupráce.

Vulvovaginal discomfort is generally the most common reason for visiting a gynaecological clinic. The acute complaints are, in most cases, solved by a gynaecologist himself and the decision procedure is based on possibilities arising from outpatient examination. If need be, the evaluation of wet preparation should be carried out. In many cases we have been confronted with discrepant diagnosis where severe difficulties are not accompanied by relevant development of inflammatory changes and thus the diagnosis gives us an impression of quandary. In this case microbiological examination is the logic solution. With regard to changing living conditions we can expect in the future, that clinical symptoms of vulvovaginitis will not be entirely clear. The overview article points out the possibilities, which a gynecologist is able to use within differential diagnosis in the outpatient department. It also emphasis the necessity of interdisciplinary co-operation, particularly in patients with chronic difficulties where erudite evaluation of fixed preparation and culture examination are beneficial.

[Mumps--a reemerging infection? The current incidence of mumps in the East Bohemian region in the Czech Republic]. / Príusnice--znovu se vracející infekce? Soucasná situace ve výskytu príusnic ve východoceském regionu.

A review of mumps outbreaks among both non-vaccinated and vaccinated children and young adults in the East Bohemian region in 2003-2005 is presented. A significant increase in mumps cases was observed over this period. The clinical diagnosis was confirmed serologically by ELISA detection of IgM antibodies and/or IgG seroconversion and increased levels of IgG antibodies. A reverse transcriptase nested PCR was introduced for direct detection of mumps virus RNA from clinical specimens (nasopharyngeal secretion, saliva, CSF and serum). The isolated RNA will be stored for further analysis and mumps virus genotyping attempts, helpful in tracing the virus circulation in the East Bohemia region. Possible causes of the recent significant increase in mumps cases among the vaccinated population in the Czech Republic are discussed.

[Chlamydia infections in urogenital tract--application of direct immunofluorescence in the diagnostics of Chlamydia trachomatis in the East Bohemian Region of Czech Republic during 1997-2003]. / Chlamydiové infekce urogenitáln'iho systému-- vyuzití prímé imunofluorescence v diagnostice Chlamydia trachomatis ve východoceském regionu Ceské republiky v letech 1997-2003.

OBJECTIVE: The aim of the study was an evaluation of results of Chlamydia trachomatis antigen detection by means of direct immunofluorescence in samples from patients suspected from this infection. DESIGN: Retrospective study. SETTING: Institute of clinical microbiology, University Hospital and Medical Faculty of Charles University, Hradec Králové. METHODS: Samples from females were swabs from uterine cervix, vagina and urethra, from male urethral swabs; moreover conjunctival swabs, bronchoalveolar irrigation, lower respiratory tract aspirates and sputum. Samples were fixed and "dyed" with monoclonal specific antibody labeled by fluorescent dye in the lab with a commercial diagnostic kit and they were evaluated microscopically after adding a drop of glycerol and covering with a top slide. RESULTS: Within a group of 6126 samples from patients suspected from Chlamydia infection we have found positivity in 14.4%. Of this subgroup 14.1% in samples from genitourinary tract of females and 15.2% in males, 14.1% from conjunctival swabs and 3.7% from lower respiratory tract. According to an age differentiation, positive samples in individual life-decades from genitourinary tract were 0-13-14.4-13.9-13.9 and in females over 60 13.9%. In males the corresponding walues were 0-21.4-15.1-16-13.4 and those over 60 years 16%. So, the highest positivity in our region has been detected in samples from young men aged 20-30, where it is nearly two-fold higher comparison to age-matched females. CONCLUSION: Direct detection of Chlamydia trachomatis antigen with immunofluorescence method still remains a reliable diagnostic tool. But for a control or confirmation of disputable results it is inconditionally necessary to have at least one more method available, e.g. PCR.

[Systemic immunity in patients with recurrent vulvovaginal candidiasis]. / Systémová imunita u pacientek s rekurentní vulvovaginální kandidózou.

OBJECTIVE: This study was undertaken to characterize systemic immunity in the patients with recurrent vulvovaginal candidiasis. SUBJECT: Original prospective study. SETTING: 1. Department of Biological and Medical sciences, Charles University in Prague, Faculty of Pharmacy, Hradec Kralove, 2. Department of Obstetrics and Gynaecology, Medical Faculty, Hradec Kralove, Charles University in Prague, 3. Department of Clinical Immunology and Allergology, University Hospital, Hradec Kralove, 4. Department of Clinical Microbiology, University Hospital, Hradec Kralove, Czech republic. SUBJECT AND METHOD: Basic immunological parameters in 44 patients with recurrent vulvovaginal candidiasis were investigated and analyzed in this longitudinal follow-up study. CONCLUSION: Although there is no fundamental disturbance in systemic immunity in patients with recurrent vulvovaginal candidiasis and the majority of systemic immunological parameters in the patients were within normal range, some subtle changes of a few parameters of humoral and cellular immunity in contrast to the controls were identified.

[Schistosomiasis of the female genital tract]. / Schistosomóza pohlavního ústrojí zen.

OBJECTIVE: Female genital tract disorders as a possible complication of schistosomiasis. DESIGN: Literature review focused on pathogenesis and clinical symptoms of female genital schistosomiasis (FGS) including diagnosis and therapy of the disease. SETTING: National Reference Laboratory for Tissue Helminthoses, Prague. METHODS: An analysis of literature data dealing with the health hazards due to bathing in natural freshwater bodies in tropics and subtropics. RESULTS: Intestinal and urinary schistosomiasis are occasionally detected in the Czech Republic, therefore, genital form of the disease in females cannot be excluded in gynecological practice. CONCLUSION: Until the present time the disease represents an uncommon finding in the routine gynecological practice in Europe and, due to a variety of symptoms which accompany FGS, the diagnosis of the disease can be delayed. As the number of immigrants from endemic countries as well as the number of travellers to these regions arises in the Czech Republic at present, the paper, therefore, summarises recent parasitological, clinical and epidemiological characteristics of female genital schistosomiasis.

[Antifungal immunity and its mechanism in female genitalia]. / Protihoubová imunita a její mechanismy ve vztahu k zenskému genitálu.

OBJECTIVE: A review of immunological aspects of fungal infections with focus on vulvovaginal candidiasis. DESIGN: Review. SETTING: Department of Obstetrics and Gynaecology, Medical Faculty, Hradec Kralove, Charles University in Prague, Department of Biological and Medical sciences, Faculty of Pharmacy, Hradec Kralove, Charles University in Prague, Department of Clinical Immunology and Allergology, University Hospital, Hradec Kralove, Department of Clinical Microbiology, University Hospital, Hradec Kralove. SUBJECT AND METHOD: Survey and discussion of current immunological aspects of vulvovaginal candidias based on literature review and personal experience. CONCLUSION: The current knowledge of immunity to Candida vulvovaginitis, particularly from experimental studies on animal models, support a more relevant role of local protection mechanisms than systemic immunity. As a consequence of this compartmentalization of the immune response, the role of innate and adaptive immunity remains unclear. The development of vulvovaginal candidiasis depends on a number of factors, including both the individual predisposition of a macroorganism and the properties of a fungal strain, and the environmental conditions influencing a delicate balance between the host and the yeast.

[Fournier's gangrene]. / Fournierova gangréna.

The authors present their own experiences with diagnostics and treatment of men with necrotising fasciitis of the scrotum (Fournier's gangrene). During 1995-2001 8 men were treated for the above diagnosis at the Clinic of Urology, Faculty Hospital in Hradec Králové. Six cases were patients with diabetes type II, in one patient we found during basic examinations a large tumour of the sigmoid and one patient was 7 days after total scrotal orchiectomy (because of prostatic adenocarcinoma). Repeated open revision under general anaesthesia was performed in all men with necessary necrectomy, testicles were intact (except a patient after orchiectomy). The infection was spread into the hypogastric area in two patients and in one patient spontaneous rupture of bulbar urethra occurred. By a combination of antibiotic therapy and repeated necrectomies, open wound healing and wet compresses we achieved cure of infection and granulations, which made final scrotal plastic surgery possible. From microbiological point of view it was mixed aerobic and anaerobic flora.

[Aspergillosis--a rare complicating disease in patients after renal transplantation]. / Aspergilóza--vzácné komplikující onemocnení u nemocných po renální transplantaci.

The authors submit a detailed analysis of the death of a 42-year-old man after a second renal transplantation. The patient died with symptoms of cardiac failure in a septic condition of obscure etiology where even detailed examination did not provide a timely answer as regards the lethal pathogen. Aspergillus fumigatus is a rare lethal pathogen. Despite this it is, as all opportune infections, for patients with immunosuppressive therapy a serious life threatening infection [1, 2]. In a group of 650 transplantations performed since 1961 in Hradec Králové it is the first death caused by generalized Aspergillus infection.

[Comparison of 2 methods of diagnosis of changes in transplanted kidneys in the early postoperative period: biopsy vs dynamic scintigraphy of the graft]. / Srovnání dvou metod v diagnostice zmen transplantované ledviny v casném pooperacním období: biopsie versus dynamická scintigrafie stepu.

Renal transplantation is at present a standard therapeutic method in chronic renal insufficiency. For a favourable development of the graft some investigated criteria are of basic importance: basic diagnosis which led to renal failure, period of dialyzation treatment, high standard collection and perfusion and early diagnosis of the rejection episode. Non-invasive diagnostic methods of the rejection episode are always indirect and correlate with histologically confirmed rejection, depending on the period of transplantation in 10-90% patients. Indirect diagnosis is based in particular on a rise of the creatinemia, decline of glomerular filtration, fluid retention variations of blood pressure and increase of the Doppler assessed index of resistance (IR) in the peripheral veins of the graft [1]. For many years the role of nuclear diagnostics are tested. The disadvantage of direct diagnosis--biopsy--is increased haemorrhage and loss of the graft [1, 2, 3, 4]. The greatest problem is the differentiation of acute (cellular) rejection as compared with acute tubular necrosis during the initial days after transplantation. The authors describe their experience with 81 biopsies in the course of 3 years in patients during the first 10 days after transplantation, comparison with dynamic scintigraphy of the graft. Their attention is focused on the technique and risks of renal biopsy.