Enteric fever imported to the Czech Republic: epidemiology, clinical characteristics and antimicrobial susceptibility.

The aim of this study was to describe epidemiological and clinical characteristics of imported enteric fever in Czech travellers and to determine the antimicrobial susceptibility of isolated strains. Retrospective descriptive study included adult patients treated with enteric fever at Hospital Na Bulovce during January 2004-December 2012. A case of typhoid or paratyphoid fever was defined as isolation of Salmonella Typhi or Paratyphi from blood or stool. During the study period, there have been diagnosed 19 cases of enteric fever (12 males and 7 females) with age median of 30 years; 14 cases were caused by Salmonella Typhi and 5 cases by S. Paratyphi A. The infection has been acquired in South Asia (16 patients; 84.2 %), in Africa (Egypt, Angola) in two cases (10.5 %), and in Mexico (1; 5.3 %). Symptoms included fever (all patients), diarrhoea (16 cases; 84.2 %), headache (9; 47.4 %), and abdominal pain (7; 36.8 %). Seventeen patients (89.5 %) were treated with fluoroquinolones; however, the treatment failure was observed in seven of them (41.2 %). Decreased ciprofloxacin susceptibility was detected in eight strains (66.7 %), and one strain (8.3 %) was multidrug resistant. Sequence analysis of quinolone resistance-determining regions (QRDR) of the gyrA gene revealed the presence of amino acid substitutions in all tested isolates with decreased ciprofloxacin susceptibility. Typhoid and paratyphoid fevers represent epidemiologically important diseases that may lead to potentially life-threatening complications. Major issue in the management of enteric fever represents the non-susceptibility of Salmonella strains to fluoroquinolones and other antimicrobials.

[The demonstration of tuberculosis using molecular genetic methods polymerase chain reaction (PCR) and Amplified Mycobacterium tuberculosis direct (AMTD) test]. / Prukaz tuberkulózy pomocí molekulárne genetických metod: polymerázové retezové reakce (PCR) a Amplified Mycobacterium tuberculosis direct (AMTD) testu.

INTRODUCTION: Tuberculosis is a communicable disease, in most instances with a chronic course. The aetiological agent is Mycobacterium tuberculosis. Its demonstration is based on microscopic investigations and cultures. Microscopy is not sufficiently sensitive, while cultures are lengthy. One of the possibilities of speeding up diagnosis are molecular genetic methods. PURPOSE OF THE STUDY: To compare the demonstration of mycobacteria using molecular genetic methods with the results of cultures. METHODS: We used two methods to demonstrate the nucleic acid complex of Mycobacterium tuberculosis-the polymerase chain reaction (PCR) and the Amplified Mycobacterium tuberculosis direct test (AMTD). We investigated 647 samples. Out of these, 275 samples were tested with PCR and 372 were investigated with a AMTD set. At the same time we started for each sample a parallel culture. RESULTS: In 275 samples, out of a total of 647, which were analysed with PCR, mycobacterial DNA was demonstrated in 18 (6.5 %). Out of the 372 samples investigated with AMTD, mycobacterial RNA was demonstrated in 27 (7 %). Out of the 18 PRC positive samples, 6 (13 %) did not yield a positive mycobacterial culture. Out of the 27 positive results RNA with the AMTD method 17 did not yield positive cultures. On the other hand, a diagnosis of tuberculosis verified by cultures without a positive PCR was found in 2 patients (0.7 %). Disagreement between the results of AMTD and cultures was also found in 2 samples (0.5 %). CONCLUSIONS: Molecular genetic methods substantially speed up the diagnosis of tuberculosis. These methods are particularly important in cases of paucibacillary material and of unique and unrepeatable samples (tissues biopsies, nodes, cerebrospinal fluid). Given the possibility of false positive results, parallel verification by microscopy and cultures is essential.

[Practical experience with patients infected or colonized with a methicillin - resistant strain of Staphylococcus aureus (MRSA).].

PURPOSE: To present the range of diseases produced by a methicillin-resistant strain of Staphylococcus aureus (MRSA). To assess the efficacy of procedures likely to cure MRSA infections and possibly to eradicate colonization. METHODS: Clinical trial studying the course of MRSA infections or colonization of in-patients, treated at the Department of Infectious Diseases of the Teaching Hospital Na Bulovce, Prague, between 1 January 2004 and 31 August 2005. The trial also took into account the results of these patients follow-up as out-patients. RESULTS: Included in the trial were 59 patients-22 presenting MRSA infections and 37 MRSA colonization. In 14 patients we found simultaneous colonization in several anatomical sites, while in 15 patients we saw, in addition to the MRSA infection, colonization at another site. Among the infections most frequent were infections of soft tissues (11), while colonization occured chiefly in the nasal mucosa (14) and in skin defects (8). In the treatment of mild infections we had good results with co-trimoxazole, in the treatment of colonizations mupirocine in the form of ointment (Bactroban ung.). During a six-month follow-up of 25 MRSA-positive patients at our Out-patient Dpt. we saw the disappearance of the MRSA strain in 7 subjects (28 %). CONCLUSION: In a significant proportion of MRSA-positive patients the MRSA strain disappears either after treatment or spontaneously. The development of MRSA colonization may be studied in out-patient follow-up.