A high frequency of viral agents yet absence of Borrelia burgdorferi is seen within the myocardium of subjects with normal left ventricular systolic function: an electron microscopy study.

A wide range of viral agents is associated with the development of acute myocarditis and its possible chronic sequela, dilated cardiomyopathy (DCM). There is also increasing evidence that Borrelia burgdorferi (Bb) is associated with DCM in endemic regions for Bb infection. This study sought to use electron microscopy to prospectively analyze the presence of viruses and Bb within the myocardium of 40 subjects with preserved left ventricular (LV) ejection fraction and 40 patients with new-onset unexplained DCM during the same time period. Virus particles were found within the myocardium of 23 subjects (58%) of both cohorts studied, yet there was no statistically significant difference in virus family presence between those with DCM versus those with preserved LV systolic function. In contrast, Bb was detected only in those subjects with DCM (0 versus 5 subjects; p ˂ 0.05). Polymerase chain reaction was performed on samples from patients who were positive for Bb according to electron microscopy, and Bb was confirmed in 4 out of 5 individuals. Our results demonstrate that the prevalence of viral particles does not differ between subjects with preserved LV systolic function versus those with DCM and therefore suggests that the mere presence of a viral agent within the myocardium is not sufficient to establish a clear link with the development of DCM. In contrast, the presence of Bb was found only within myocardial samples of patients with DCM; this finding supports the idea of a causal relationship between Bb infection and DCM development.

Electron microscopy in the diagnosis of viral gastroenteritis in hospitalised children in the Czech Republic.

Our study has been aimed at demonstrating the main role of viruses in the aetiology of acute gastroenteritis in children less than 5 years old and at pointing out the diagnostic potential of electron microscopy in the diagnosis of viral gastroenteritis. A prospective study was conducted to analyse the aetiology of diarrhoeal diseases in children less than 5 years of age admitted to the Department of Infectious Diseases between September 2006 and December 2008. All children were tested by faecal culture, latex agglutination and electron microscopy. A total of 832 children were included in the study. An aetiological agent was detected in 788 children (94.6 %). A bacterial aetiology was found in 22 (2.6 %) children and bacterial-viral co-infection was found in 146 (17.6 %) patients. The most frequent causative agents of gastroenteritis in children were viruses, which were detected in 620 (74.5 %) patients. The main causes of viral gastroenteritis were rotaviruses (detected in 410 children), followed by caliciviruses (42), coronaviruses (28), adenoviruses (19) and astroviruses (14). Dual viral infections were detected in 107 children, with rotavirus-calicivirus co-infection being the most common. Electron microscopy proved to be a more sensitive method in comparison with the latex agglutination test for the diagnosis of rotaviruses and adenoviruses. The major role of viruses in diarrhoeal diseases among children under 5 years of age in the Czech Republic has been confirmed. The diagnostic potential of electron microscopy, particularly in small outbreaks of gastroenteritis, was clearly shown.

Presence of Borrelia burgdorferi in endomyocardial biopsies in patients with new-onset unexplained dilated cardiomyopathy.

Dilated cardiomyopathy (DCM) represents the third most common cause of heart failure and the most frequent cause of heart transplantation. Infectious, mostly viral, and autoimmune mechanisms, together with genetic abnormalities, have been reported as three major causes of DCM. We hypothesized that Lyme disease (LD), caused by spirochete Borrelia burgdorferi (Bb), might be an important cause of new-onset unexplained DCM in patients living in a highly endemic area for LD such as the Czech Republic. We performed endomyocardial biopsy (EMB) in 39 consecutive patients presenting with symptomatic unexplained left ventricular (LV) systolic dysfunction lasting no more than 12 months. In eight subjects (21%), Bb was detected in the EMB sample by polymerase chain reaction or by electron microscopy. None of these patients exhibited any form of atrioventricular block or other extracardiac manifestation of Bb infection. Serological testing identified IgG antibodies against Bb in only two cases and IgM antibodies in none. All affected patients were treated with intravenous ceftriaxone for 3 weeks. At 6 months follow-up, LV morphology and function as well as functional status of these patients significantly improved. In conclusion, Bb infection may represent an important cause of new-onset unexplained DCM in patients living in endemic regions such as the Czech Republic. Because the antibiotic treatment appears to be markedly effective and serological examination does not provide a tool for diagnosing the disease, EMB focused on the detection of Bb should be performed in all patients from endemic areas with new-onset unexplained DCM not responding to conventional therapy.

Successfully resuscitated sudden cardiac death in a young homosexual male with HIV myocarditis.

Successfully treated sudden cardiac death due to malignant arrhythmia related to HIV myocarditis in a young male with favorable clinical and virological profile is not described in current literature. HIV myocarditis as a possible cause of malignant ventricular arrhythmia and sudden cardiac death is discussed.

[Viral gastroenteritis in children]. / Virové gastroenteritidy u detí.

UNLABELLED: PURPOSE OF THE TRIAL: To establish the involvement of viruses in the aetiology of diarrhoeal disorders in children, the incidence of individual viruses in various age groups and in different seasons, the impact of the aetiological agent on the clinical picture, the severity of the disorder, therapy and duration of hospital stay. The significance of intestinal viruses as nosocomial pathogens,a comparison of the sensitivity of latex agglutination and electron microscopy in the diagnosis of rotaviruses and adenoviruses. PATIENTS AND METHOD: 496 children, aged 3 weeks to 15 years, admitted in 2002 to the 1st Dpt of Infectious Diseases of the Bulovka Teaching Hospital with a diarrhoeal disorder, were examined to establish the aetiology of their complaint. All the children had the usual faecies culture and a culture of Campylobacter jejuni; direct electron microscopy was used for the demonstration of viruses. Additionally, latex agglutination was used in the investigation of rotaviruses and adenoviruses. In indicated cases the stools were also investigated for the presence of Clostridium difficile and of parasites. RESULTS: Viruses were the most frequent cause of diarrhoeal diseases in children. Some type of virus was found in 413 children (83.26 % of the patients). Pure bacterial aetiology was seen in 35 children (7.05 %), pure viral aetiology in 381 children (66.73 %). A mixed infection, due to a combination of a bacterium and a virus, was found in 82 subjects (16.53 %), in 45 children (9.07 %) the aetiology of the disease could not be established. Rotaviruses, the most frequent infectious agent, were found in 300 children (6.48 %), caliciviruses in 68 (13.7 %), adenoviruses in 63 (12.7 %), coronaviruses in 39 (7.86 %), astroviruses only in 2 children (0.40 %). Children aged 1 to 5 years were the age group most affected by all the viral agents. The incidence of all the viruses, with the exception of coronaviruses, was highest in the cold seasons, the highest incidence of rotaviruses was in April. The most severe course of the disease was seen in rotaviral infections; 74.07 % of the children presenting with rotaviral gastroenteritis required rehydration, either i.v. or with a nasogastric tube. The longest hospital stay (5.29 days) was with adenoviruses. Nosocomial infections caused by rotaviruses were found in 5 cases-they substantially prolonged the mean time of hospital stay (13 days). Electron microscopy proved more sensitive than latex agglutination in the diagnosis of rotaviruses and adenoviruses. CONCLUSIONS: The results of our trial confirmed the key role of viruses in the aetiology of diarrhoeal disorders in children in the Czech Republic. Given their frequently severe course, especially in the case of rotaviral infections, it is advisable to launch regular vaccinations against rotaviruses, once the new vaccine is on the market. It would also be appropriate to improve the diagnosis of rotaviruses and their reporting in the Czech Republic and, last but not least, to apply-at least on a limited scale-modern procedures, i.e. molecular-genetic methods, in the diagnosis of viral intestinal disorders.