[Pneumococcal meningitis in children]. / Pneumokoková meningitida u detí.

OBJECTIVE: Presented are the authors' own experiences with invasive pneumococcal diseases in a group of pediatric inpatients with pneumococcal meningitis treated in the Department of Infectious Diseases, University Hospital and Charles University Faculty of Medicine in Hradec Králové over the last 10 years. MATERIAL AND METHODS: A group of patients aged 0-18 years and hospitalized in the above facility in 2002-2011 was retrospectively assessed. The patients' basic clinical characteristics and treatment outcomes are shown below. RESULTS: Over the study period, 27 children with pneumococcal meningitis were treated; of those, 15 were boys and 12 were girls. The patients' ages ranged from 2 days to 17 years; seventeen children (63 %) were younger than 2 years. On admission, 11 children (40 %) had the infection in the middle ear or paranasal sinuses; intracranial complications were noted in 10 cases. Cerebrospinal fluid culture was positive for Streptococcus pneumoniae in 21 cases. In 6 patients, pneumococcal DNA was determined in the cerebrospinal fluid by PCR. None of the studied patients died. Eight children (29 %) were left with permanent damage; of those, seven had hearing impairment. CONCLUSION: Even today, pneumococcal meningitis in children remains a serious condition posing a risk of dangerous consequence or even death. To the maximum extent possible, prevention should include vaccination, especially in infants and children with the predisposing factors.

[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.

[Invasive streptococcal infections]. / Invazivní streptokokové infekce.

The severity of streptococcal infections depends upon different virulence of individual strains of its causative agent. The most important species are beta-haemolytic group A streptococci (GAS). Clinical manifestations include skin affections, respiratory tract infections and, in particular, serious systemic invasive infections. The pathogenicity of GAS is derived from cell wall components and extracellular products, especially toxins with properties of the so-called superantigens. Less invasive forms of the disease are include necrotizing fasciitis, myositis, pneumonia, sepsis without focus, arthritis, meningitis, puerperal sepsis, streptococcal toxic shock syndrome (STSS) and severe course of erysipelas and cellulitis with blood culture positive for GAS. In most cases, soft tissue infections dominate, often accompanied by chronic diseases of lower extremities in elderly patients. The other clinical forms are rather rare. In children, the condition is clearly frequently related to chickenpox. The generally accepted therapeutic management comprises comprehensive intensive care, early administration of penicillin in combination with clindamycin, and surgical intervention. The use of intravenous immunoglobulins (IVIG), elimination methods and hyperbaric oxygen are under discussion. The slight increase in cases and ineffective prevention require rapid assessment of diagnosis and adequate treatment as a protracted course of the condition is connected with a high mortality rate.