[Cat scratch disease - a neglected zoonosis]. / Nemoc z kocicího skrábnutí - opomíjená zoonóza.

Cat scratch disease is a relatively rare infection that is caused by the bacterium Bartonella henselae. This disease occurs after cat scratch or bite. The course of the disease depends on the patients immunity status. In immunocompetent patients, the disease typically runs as a lymph node syndrome. Sometimes, mild general symptoms may appear, or the course can be atypical with a more serious clinical manifestation involving various organs. In immunocompromised patients, Bartonella henselae can cause bacillary angiomatosis or peliosis with a severe course.

[Cat scratch disease: still current zoonosis]. / Felinóza- stále aktuální zoonóza

OBJECTIVES: A retrospective evaluation of a group of patients which is focused on clinical picture, serological diagnosis, therapy and familial occurrence of the disease. MATERIAL AND METHODS: Cat scratch disease (CSD) was considered within the scope of a differential diagnosis of lymphadenopathy. Serological diagnosis was based on detection of antibodies against Bartonella henselae by indirect immunofluorescence, where the level of IgG antibodies of at least 1 : 256 or any positive level of IgM antibodies were considered positive for CSD. If a histological examination was conducted, the suspicion of CSD was supported by finding granulomatous inflammation. Macrolides were used for treatment in both children and adults. In addition to macrolides, doxycycline was used in adults. RESULTS: From 2004 to 2013, a total of 27 patients aged 7-73 years were diagnosed with CSD at the Clinic of Infectious Medicine, University Hospital in Ostrava. None of them suffered from immunodeficiency detected earlier. Diagnostic extirpation of a lymph node was performed in 5 patients diagnosed with granulomatous inflammation. Lymph node syndrome was observed in all patients, with cervical, inguinal and axillary nodes being most frequently affected. However, two patients had supraclavicular nodes affected and a 52-year-old woman had unusual swelling of lymphatic tissue in the scapular region with skin lesions. Lymph node syndrome accompanied by encephalopathy was observed in one 50-year-old patient. Positive IgM antibodies were detected in only 8 patients. There were two cases of familial occurrence affecting 2 and 3 family members. Antibiotic therapy with full resolution of clinical findings was successful in 24 patients, including the patient with encephalopathy. In spite of the antibiotic treatment, three patients developed lymph node colliquation requiring surgical intervention. CONCLUSIONS: Atypical lymph node localization in 3 patients, encephalopathy in 1 patient, positive levels of IgM antibodies in 8 only patients, delayed antibodies production in 4 patients and antibiotic therapy coupled with extirpation of colliquated lymph nodes in 3 patients were found in the group of 27 patients.

[Evaluation of prophylactic precautions after exposure to biological materials]. / Hodnocení profylaktických opatrení po expozici biologickému materiálu.

OBJECTIVES: Study of transmission rates of hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) and effect of HBV vaccination after parenteral exposure to biological materials. PATIENTS AND METHODS: This was a retrospective study of 879 individuals (419 health care professionals and 460 persons from the general population) after blood and body fluid exposure examined at the Clinic of Infectious Diseases in Ostrava from 1999 to 2013. HBsAg, anti-HBs, anti-HBc, anti-HCV, anti-HIV, bilirubin, and ALT were tested in exposed patients and known sources at the baseline and, except anti-HBc, after 3, 6, and 12 months. Susceptible persons were vaccinated against HBV and screened for anti-HBs after 1-2 months. Antiretroviral prophylaxis was provided if reasonable. RESULTS: At the baseline, 42 exposed persons were HBV positive, six were HCV positive, and none was HIV positive. During the follow-up, no new HBsAg positivity was detected in exposed individuals, although 25 of 837 susceptible persons were exposed to HBsAg-positive sources. After vaccination, protective anti-HBs were detected in 707 (84.7%) of 837 susceptible persons and in 709 (97.8%) of 725 persons with known post-vaccination response. Fifty-six of 873 persons had been exposed to HCV-positive sources and HCV transmission was shown in three (two health care professionals) of them. No HIV transmission was observed, although 11 of 879 individuals had been exposed to HIV-positive sources, with antiretroviral prophylaxis provided to nine of them. CONCLUSIONS: Contemporary post-exposure prophylactic precautions in the Czech Republic can be considered as adequate for the prevention of HBV and HIV, but health care professionals in particular are at risk of HCV transmission.

[The use of electron microscopy and virus isolation in the diagnosis of aseptic neuroinfections]. / Vyuzití elektronové mikroskopie a izolace viru v diagnostice aseptických neuroinfekcí.

OBJECTIVE: In aseptic neuroinfections, the etiology is usually known in 50-70% of cases. The aim was to increase the rates using electron microscopy (EM) and virus isolation in cell cultures. MATERIAL AND METHODS: The prospective study included 34 patients with aseptic neuroinfections hospitalized at the Department of Infectious Diseases in Ostrava fromJuly to November 2012. EM examined cerebrospinal fluid of all patients and virus isolation in tissue cultures was performed in all cerebrospinal fluid samples. Cerebrospinal fluid was examined by polymerase chain reaction for enteroviruses in 30 patients and for herpes simplex virus 1 and 2 in 29 patients. Detection of antibodies against Borrelia burgdorferi and tick-borne encephalitis was performed in all 34 patients. RESULTS: Possible etiological agents were discovered in 31 out of 34 patients (91%), with one agent being found in 23 patients (68%) and two agents being detected in 8 patients (24%). EM revealed the agents in 26 patients and virus isolation was successful in 10 patients. EM was the only method to identify 10 agents. A group of 23 patients with a single agent detected included 14 patients with enteroviral meningitis, 4 patients with Lyme borreliosis and 4 patients with tick-borne encephalitis; EM detected an undefined virus in the last patient. An unusual group of 8 patients with two agents detected comprised 5 patients with enteroviruses and spirochetes, 2 patients with tick-borne encephalitis and undefined viruses and 1 patient with a spirochete and an undetermined virus. CONCLUSION: EM can aid in explaining the etiology of aseptic neuroinfections. However, the clinical interpretation of results remains problematic, such as detection of unknown viruses or two possible agents in 8 out of 34 patients.

[Primary meningococcal conjuctivitis with the development of a systemic disease]. / Primární meningokoková konjunktivitida s rozvojem invazivního onemocnení.

Neisseria meningitidis is a rare cause of acute bacterial conjunctivitis. Systemic meningococcal disease follows meningococcal conjunctivitis in approximately one quarter of patients. Systemic antibiotic treatment is indicated in the case of meningococcal conjunctivitis to prevent spread of infection. We report 6-month-old boy who presented with meningococcal conjunctivitis and developed sepsis and meningitis in 24 hours. The course of the disease was favorable.

[Vaccination against hepatitis B in patients with chronic renal failure--twenty years follow-up]. / Ockování proti virové hepatitide B u pacientu s chronickým selháním ledvin--dvacetileté zkusenosti.

AIM: The efficacy of vaccination against hepatitis B was evaluated in patients with chronic renal failure from 4 dialysis units in 1988-2010. PATIENTS AND METHODS: Hepatitis B vaccination was started in 1 271 patients with chronic renal failure (606 female, 665 male). Patients received intramuscularly 3 doses of plasma-derived or since 1990, recombinant vaccine at the interval 0, 1 and 2 months for dialysis patients and 0, 1 and 6 months for pre-dialysis patients. Each vaccine contained 40 microg of hepatitis B surface antigen (HBsAg) in 1 002 patients, however only 20 microg HBsAg in 269 patients till 2000. Blood samples were obtained at the beginning of vaccination, 1-2 month after immunization and biannual thereafter. Serum samples were tested using ELISA methods for HBsAg and antibodies against hepatitis B surface and core antigens (anti-HBs, anti-HBc). The patients without protective anti-HBs level and the patients with waning of anti-HBs antibodies were revaccinated. RESULTS: Anti-HBs antibodies after the third vaccine were investigated in 786 patients. Protective anti-HBs levels (> or = 10 IU/l) were proved in 49%, 65% and 74% patients after the third, fourth and fifth vaccine. The waning of protective anti-HBs antibodies was detected in 47% and 68% of patients during 3 and 5 years after vaccination. The new infections with HBsAg positive status were proved in 28 patients, in 27 of them in period 1988-1994. Anti-HBc seroconversion was observed in 10 patients. CONCLUSION: Vaccination considerably reduced hepatitis B incidence in the patients with chronic renal failure during nineties. However still approximately one quarter of patients did not produce protective anti-HBs level after immunization with recombinant vaccine and new form of vaccination against hepatitis B may be considered also in the Czech Republic.

[Hepatitis B immunization of patients with inherited bleeding disorders: personal experiences]. / Vlastní zkusenosti s ockováním proti virové hepatitidé B u pacientu s vrozenou poruchou koagulace.

Hepatitis B immunization of patients with inherited bleeding disorders: personal experiences Hepatitis B vaccination was initiated in 55 patients with inherited bleeding disorders in 1994-2009. Patients received three doses of subcutaneous recombinant vaccine containing 20 mg HBsAg (hepatitis B surface antigen) at 0, 1 and 6 months. Blood samples were obtained at the starting of vaccination, 1-3 months after immunization, and biennially thereafter. The samples were tested for HBsAg, hepatitis B surface and core antibodies (anti-HBs, anti-HBc). Protective anti-HBs level (≥10 IU/l) after immunization was proved in 50 of 51 patients (98 %). Waning of protective anti-HBs antibodies was detected in 4 % and 24 % of patients within 5 and 10 years after vaccination. No HBsAg carrier status or anti-HBc seroconversion were detected. Subcutaneous vaccination against hepatitis B provides long-term protection in patients with inherited bleeding disorders.

Long-term protection against hepatitis B after newborn vaccination: 20-year follow-up.

BACKGROUND: Hepatitis B vaccination in children born to hepatitis B surface antigen (HBsAg)-positive mothers considerably decreases the risk of vertical transmission. However, whether this protection against carriage of hepatitis B virus is maintained into early adulthood is as yet unknown. PATIENTS AND METHODS: A combined passive-active immunization programme for newborns of HBsAg-positive mothers was initiated in the north-eastern part of the Czech Republic in 1988. The number of immunized newborns had reached 665 newborns by the end of 2006. All mothers of immunized infants were HBsAg-positive during pregnancy, and 34 (5%) were also hepatitis B e antigen (HBeAg)-positive. The immunization programme consists of providing newborns with protection at birth with hepatitis B immunoglobulin, followed by three 10-µg doses of plasma-derived or, since 1990, recombinant vaccine administered at 0, 1 and 6 months of life. Only 29 children of HBeAg-positive mothers received vaccine at 0, 1 and 2 months of life. Blood samples were obtained after immunization, at 2 years of age, and biennially thereafter. Samples were tested for HBsAg and hepatitis B surface and core antibodies (anti-HBs, anti-HBc). RESULTS: The immunization schedules were completed in 640 children. A protective anti-HBs level after immunization was proven in 574 of 620 children (93%). Persistence of protective anti-HBs antibodies was detected in 70, 40 and 25% of children at 5, 10 and 15 years of age. Vertical transmission with chronic HBsAg carrier status was detected in two infants. Anti-HBc seroconversion was proven in ten children from 3 to 15 years of age. Natural boosting with an anti-HBs increase was detected in 38 children (twice in one child). CONCLUSION: Our results show that combined active-passive immunization of newborns against hepatitis B provides persistent protection up to adolescence despite a frequent waning of anti-HBs antibodies, suggesting there is no need for booster vaccination during adolescence.

[Retreatment with peginterferon plus ribavirin in chronic hepatitis C patients: our own experiences]. / Opakovaná lécba pegylovaným interferonem s ribavirinem u pacientu s chronickou hepatitidou C - vlastní zkusenosti.

Retreatment with peginterferon plus ribavirin was initiated in 26 patients with hepatitis C virus genotype 1b infection (17 relapsers after the first course of therapy, 9 non-responders). So far, retreatment has been completed in 19 patients, one patient achieved a sustained virologic response, and 3 patients were relapsers. Therapy was discontinued in 14 patients (9 non-responders) because of a lack of a treatment response, and in 1 patient due to adverse effects. Retreatment is a new chance for patients with chronic hepatitis C infection. However successful outcome is rare especially in non-responders.

[Alveolar echinococcosis--a new emerging disease?]. / Alveolární echinokokóza--nove se objevující onemocnení?

Alveolar echinococcosis is a rare zoonotic disease caused by the cestode larval stages of Echinococcus multilocularis. The Larva develops as a tumour like cyst (hydatid). Due to a slow cyst development, the early stage of the infection is always asymptomatic and the clinical symptoms develop after years later. In the Czech Republic the disease is still very rare. Only one alveolar echinococcosis case was reported 30 years ago. However, new alveolar echinococcosis cases occurred during last two years and some of them indicate autochtonic character of the transmission. With regard to the recent increasing risk of infection with E. multilocularis in Central Europe, we present two case reports of alveolar echinococcosis in a 33-year old woman and a 24-year old man. The reports show diagnostic process and therapy of the infection.

[Lamivudine therapy in patients with severe acute hepatitis B]. / Lécba lamivudinem u pacientu s tezkou akutní virovou hepatitidou B.

OBJECTIVES: Fulminant hepatitis develops in 1 % of patients with acute hepatitis B. Lamivudine therapy in patients with severe acute hepatitis B probably reduces their risk of fulminant hepatitis but experience with this type of treatment is still limited. MATERIALS AND METHODS: Between 1999 and 2006, 17 immunocompetent patients (12 women, 5 men, age 17-83 years) with severe acute hepatitis B were treated with lamivudine. Prior to treatment, all patients had their total bilirubin values above 220 micromol/l (more than 13 mg/dl). In 9 patients, the marked increase of bilirubin levels was accompanied by aminotransferase level decrease. Sixteen patients received lamivudine at a dose of 100 mg per day; one patient was given 150 mg daily. In 12 patients, concurrent corticosteroid therapy was administered. RESULTS: One patient developed fulminant hepatitis B and underwent successful urgent liver transplantation 5 days after the lamivudine therapy was initiated. Sixteen patients responded well to the treatment and their biochemical parameters improved rapidly. Within 3-7 months, the HBsAg was undetectable in 14 out of 15 investigated patients. Protective anti-HBs antibodies developed in 11 of them in 3-21 months. The lamivudine therapy was terminated in 12 patients and it continued for more than 1 year in 3 patients only. Four patients continue to receive lamivudine but the therapy still has not exceeded 9 months. The corticosteroid therapy was short-term; it was longer than one month in 1 of 12 patients. CONCLUSION: Early treatment with lamivudine alone or with corticosteroids probably decreases the risk of progression to fulminant hepatitis in patients with severe acute hepatitis B.

[Hepatitis B immunoglobulin treatment after liver transplantation--our experiences]. / Vlastní zkusenosti s podáním imunoglobulinu proti hepatitide B po transplantaci jater.

Liver transplantation was performed in 3 patients with hepatitis B infection in 1999-2004 years. Combination of hepatitis B immunoglobulin (HBIg) and lamivudine are used for prevention of hepatitis B recurrence. HBIg is administered in dose 2 000 international units (IU) with tendency to maintain anti-HBs antibodies above 100 IU/litre. Average interval between HBIg administrations was 22, 32 and 32 days, yearly price of treatment was 0.45-0.65 million Czech crowns. Three patients with HBIg and lamivudine therapy are still without recurrence of hepatitis B at the end of 2006 year.

Efficacy and safety of chronic hepatitis C treatment in hemophilic patients.

BACKGROUND/AIMS: Chronic hepatitis C infection is very common among hemophiliacs in the developed World. METHODOLOGY: Retrospective evaluation of the treatment results in hemophiliacs with chronic hepatitis C, all infected with genotype 1b. Twelve patients were treated with interferon-alpha monotherapy, 21 patients with interferon-alpha and ribavirin, and 3 patients with pegylated interferon and ribavirin, all for 48 weeks. RESULTS: Sustained virologic response (defined as an undetectable serum HCV RNA level 24 weeks after treatment was completed) was not achieved in any of 12 patients treated with interferon-alpha alone. Combination therapy with interferon-alpha and ribavirin was associated with better results: 4/10 (40%) patients still untreated with interferon-alpha, 2/4 (50%) relapsers, and 2/7 (29%) non-responders to previous interferon-alpha monotherapy achieved sustained virologic responses. Combination therapy with pegylated interferon and ribavirin has been used in 3 patients. Sustained response was achieved in one patient who had relapsed after treatment with interferon-alpha and ribavirin and in 1 of 2 non-responders to this combination therapy. There were no serious adverse events and it was not necessary to reduce dosages or even cease therapy prematurely. CONCLUSIONS: The efficacy and tolerability of antiviral treatment in hemophiliacs did not differ from other patients with chronic hepatitis C.

[Serological survey and vaccination against viral hepatitis A in health care providers at the Clinic of Infectious Diseases in Ostrava]. / Sérologický prehled a vakcinace proti virové hepatitide A u zdravotníku na infekcní klinice v Ostrave.

STUDY OBJECTIVE: The health care providers of the Clinic of Infectious Diseases in Ostrava were screened for immunity to hepatitis A virus (HAV) in an attempt to provide vaccination against hepatitis A to non-immune persons. STUDY SUBJECTS AND METHODS: A cohort of 101 health care providers of the Clinic of Infectious Diseases, i.e. 10 physicians, 56 nurses and 35 nursing auxiliaries, were screened. Total anti-HAV antibodies were determined by ELISA and the subjects not reaching the protective level of anti-HAV antibodies were considered as non-immune. Vaccination against hepatitis A was recommended to all of the non-immune persons. RESULTS: Immunity to HAV was detected in 41 (41%) of 101 screened subjects. Immunity was increasing with age, being found in 8% of subjects under 40 years of age and 59 % of older subjects, in 2 (20%) physicians, 23 (41%) nurses and 16 and nursing auxiliaries. Vaccination of 58 non-immune subjects was conducted without complications. CONCLUSION: The prevalence rates of total anti-HAV antibodies in health care providers of the Clinic of Infectious Diseases showed a continuing upward trend with age and were practically the same as in the community.

Administration of antibiotics before admission in patients with meningococcal disease.

PURPOSE: To determine whether parenteral or oral antibiotics given before admission to a regional hospital with a special intensive care unit (ICU) reduce the case fatality rate in patients with meningococcal disease. DESIGN: Prospective analysis of 164 consecutive patients with meningococcal disease admitted to 5 regional hospitals in the Czech Republic between August 1996 and October 2001. Main outcome measure was number of deaths from meningococcal disease. Fisher's exact test was used for statistical analysis. MAIN FINDINGS: Nine out of 116 patients (8%) given antibiotics before admission died, compared with five deaths in 48 patients (10%) admitted without such a treatment (p = 0.55). None of 19 patients given oral or combined oral and parenteral pre-admission antibiotics died. CONCLUSION: Parenteral and probably also oral antibiotics given before admission to a regional hospital and an adequate treatment of shock can reduce the case fatality rate from meningococcal disease.

Unusual hepatitis B surface antigen variation in a child immunised against hepatitis B.

Perinatal transmission of and infection with hepatitis B (HBV) in early childhood are observed in a small proportion of the offspring of hepatitis B surface antigen (HBsAg)-positive mothers who are vaccinated against HBV immediately after giving birth. The children may be infected by wild-type HBV or by variants with amino acid substitutions in the "a" determinant of HBsAg, particularly at position 145 and, rarely, at positions 120, 126, 129, 131, 141, and 144. Four hundred and forty-six newborn infants of HBsAg-positive mothers in the northeastern part of the Czech Republic received combined active and passive immunisation against HBV. Only one child became an HBsAg carrier. This followed a mild, acute HBV illness in the beginning of the second year of his life. HBV DNA encoding the "a" determinant and surrounding region of HBsAg was sequenced after amplification from the plasma of the child and his mother. The child was infected with variants of HBsAg with substitutions at residues 137 and 139. The virus of the mother had changes at residues 120 and 121. HBV from both child and mother had an unusual substitution at residue 118 and seemed to be of the ayw subdeterminant.

[Increased incidence of invasive meningococcal disease caused by C:2a:P1.2 meningococci in certain regions of the Czech Republic]. / Zvýsený výskyt invazívního meningokokového onemocnení v nekterých oblastech Ceské republiky zpusobený meningokokem C:2a:P1.2.

In the first half of 1993 an increased incidence of invasive meningococcal disease was recorded in the Czech Republic. In the CR a total of 59 cases were revealed, incl. 10 fatal ones. This high lethality (16.9%) is markedly higher than that from 036 recorded in this country during previous years. The highest incidence and death rate was recorded in the North Moravian region and in the age group from 15-19 years. Based on active surveillance of the invasive meningococcal disease by epidemiologists, microbiologists and infectiologists of the entire Czech Republic, it may be concluded that the sulphonamide sensitive strain Neisseria meningitidis C:2a:P1.2 caused in the North Moravian region a local epidemic of invasive meningococcal disease in the army and civilian population. In other regions of the CR the epidemiological situation in the first half of 1993 did not differ from the previous period: sporadic incidence of meningococcal disease, prevalence of the serological group B, highest incidence in the youngest age groups. The meningococcus C:2a:P1.2 was not detected in the CR before 1993. This uncommon epidemiological situation was resolved by immunization, aimed from the antigenic aspect and with regard to age and locality.