[Chlamydia trachomatis--a risk for reproductive capacity in women]. / Chlamydia trachomatis--riziko ohrození reprodukcní schopnosti zen.

BACKGROUND: Chlamydia trachomatis is a bacterium which causes in man among others urogenital infections. So far no data were published pertaining to the herd immunity of the population to this infection in the Czech Republic. The objective of the present investigation was to summarize clinical and laboratory results of examined women and to evaluate the assembled data by statistical methods. Special attention was paid to patients examined on account of infertility. METHODS AND RESULTS: 506 women aged 17-50 years (mean age 28 years) were examined. They were divided into five groups (1-cervicitis, 2-pelvic pain, 3-pregnant, 4-sterile, 5-before UPT). Group 4 (sterile) was further subdivided into three categories (4a IVF on account of tubal sterility, 4b IVF on account of non-tubal sterility and 4c others). With regard to the domicile the women were divided into those residing in Prague and those from other towns and rural areas. In all antigenic examinations of smears from the endocervix were made and serological examinations of specific IgA, IgG antichlamydial antibodies. During collection of the smears the appearance of the cervix; discharge, bleeding and pain on examination were evaluated. For statistical evaluation the chi 2 test was used. In 57% of the women from the whole group positive IgG antibodies were detected suggesting a past or present infection. Differences of antigenic or serological positivity between the five different groups were not statistically significant. In category 4a a significantly higher positivity of IgG (2 alpha < 0.001) of antichlamydial antibodies was found (92% patients) than in categories 4b and 4c. 71% women had complaints during examination. The authors did not find a correlation between antigen- and serum positive women indifferent groups and their domicile. CONCLUSIONS: The results provide evidence of a high herd immunity of the population of the Czech Republic to Chlamyata infection. At the same time they prove that post-inflammatory changes caused by Chlamydia trachomatis are the most frequent cause of occlusion of the oviducts and tubal sterility.

[Chlamydia trachomatis and its role in female infertility]. / Chlamydia trachomatis a její podíl na neplodnosti zen.

Infertility is a worldwide problem. 15-20% married couples are childless though they want children. The tubal factor is the most frequent cause of female infertility. Chlamydia trachomatis is one of the most frequent pathogenic organisms which cause tubal occlusion. From January 1995 till June 1997 at the 1st Dept. Gynecol. and Obstetric, 1st Fac. of Medicine 327 infertile women were examined divided into three groups (sterile, included in the IVF programme on account of the tubal factor and those included in the programme for other reasons). In all an antigenic examination from the endocervix and serological examination of antichlamydia antibodies was made. In 73 women in the IVF programme by microabrasion of the endometrium material for detection of Chlamydia infection was obtained by PCR. During sampling from the uterine cervix the appearance of the portio uteri, discharge, haemorrhage and pain on examination were evaluated. For statistical evaluation the chi square test was used. In 61% patients anamnestic IGG antibodies were detected suggesting a past or present Chlamydia infection. In women included in the IVF programme on account of the tubal factor there was a significantly higher IgG positivity (92%). Of ten women who suffered from acute chlamydial cervicitis only in one the infection was detected during microabrasion of the endometrium. 65% antigen positive patients had complaints during the examination (discharge, bleeding, pain). The authors discuss the impact of the assembled results from the aspect of impaired fertility of women in the Czech Republic.

[Treatment of chlamydial urogenital infections]. / Lécba chlamydiové urogenitální infekce.

Chlamydia trachomatis is the most frequent sexually transmitted bacterial pathogen in developed countries [3, 12, 13]. The position is similar in the Czech Republic. Depending on the group of examined women active Chlamydia infection varies between 10 and 23%. The increasing incidence of urogenital Chlamydia infections and improving diagnostic possibilities call for adequate treatment. Correct treatment of urogenital infections caused by Chlamydia trachomatis is very important for the prevention of undesirable sequelae of inflammations of the lesser pelvis, subsequent risk of GEU, sterility, prevention of premature delivery and possible infection of the neonate. When starting treatment, selecting a suitable antibiotic and deciding on the therapeutic strategy it is important to select an antibiotic with regard to its efficacy, the epidemiological situation, regional sensitivity of the infectious agent, toxicity and tolerance of the antibiotic, to its bacteriostatic or bactericide action, and last not least, also its price. Despite selection of a suitable antibiotic sometimes treatment fails. For treatment of urogenital chlamydial infections tetracyclin and macrolid antibiotics are recommended or quinolone chemotherapeutic agents of the third generation. Tetracyclines are broad spectrum antibiotics with bacteriostatic action. As to oral forms doxycycline, tetracycline and oxytetracycline are used. The most frequent undesirable effects during treatment are nausea, vomiting, diarrhoea and abdominal pain. Tetracycline antibiotics are contraindicated in children under 8 years, during pregnancy and lactation and in case of sensitivity to this group of drugs. Macrolids are antibiotics with a medium broad antibacterial spectrum with bacteriostatic action. Macrolids of the first generation have a low antibacterial activity. They have a short biological half-life, not always a good tolerance, and serious clinically important drug interactions may develop. The most frequently used preparations of the first generation include erythromycin, josamycina and spiramycin. Macrolids of the second generation, azitromycin, roxitromycin and claritromycin lack the above negative properties. The most frequent undesirable effects after administration of macrolids include nausea and vomiting. Considerable differences were found in particular between different preparations containing erythromycin. Macrolids of the second generation have only slight undesirable gastrointestinal effects. Macrolid antibiotics are contraindicated in case of sensitization to this group, in severe hepatic disorders and great care must be taken in the treatment of pregnant women. Quinolone chemotherapeutic agents of the third generation, ciprofloxacine, enoxacine, ofloxacine and pefloxacine are synthetic drugs with a broad antibacterial spectrum which act on systemic infections. On oral administration they are rapidly absorbed and the blood and tissue concentrations are sufficiently effective. In the treatment of urogenital Chlamydia infections they are useful in the treatment of chronic infections after failure of previous macrolid and tetracycline therapy. The most frequent undesirable side-effects include nausea, vomiting, meteorism, diarrhoea, tinnitus, headache, changes of mood, allergic skin reaction. They are contraindicated in hypersensitivity to quinolone chemotherapeutic preparations, in children and adolescents under 18 years, during pregnancy and lactation. The objective of the present study was to evaluate different therapeutic patterns, their efficacy and tolerance.

[Herd immunity and the role of Chlamydia pneumoniae in the etiology of respiratory diseases in the Czech Republic]. / Promorenost a úloha Chlamydia pneumoniae v etiologii respiracních onemocnení v Ceské republice.

The objective of the investigation was to assess the seroprevalence of IgG in the population of the Czech Republic and to assess the etiological role of Chlamydia pneumoniae in respiratory diseases. The sera were examined by specific tests-genus by ELISA and species by the microimmunofluorescent test. The examination of sera from 1974-1975 for the serological survey was selected to make the results comparable with the results of examinations planned for 1996. Chlamydia IgG were detected already in the age group from 1-4 years with a marked rise in youth, and in adult age the seroprevalence was between 72.0 and 86.2% (mean 80.1%). In the seropositivity of Chlamydia IgG participated mainly immunoglobulin C. pneumoniae, which was present already in child and school age (seroprevalence 7.7-88.2%), culminating in adult age (92.0-100%). IgG C. trachomatis were detected practically only in adult age, IgG C. psittaci were found only rarely in serum. In 16 subjects (of 216 examined) serological tests revealed acute (in 27 suspect), in 6 subjects recent (in 17 suspect) infection with C. pneumoniae and 53 to 63 subjects had the infection in the past.

[Parvovirus B19 in the Czech Republic. Seroepidemiologic study]. / Parvovirus B 19 v Ceské republice. Séroepidemiologická studie.

Erythema infectiosum which is caused by parvovirus B 19 is notified in the Czech Republic similarly as some other viral exanthemas under the diagnosis "Other viral infections affecting the skin and mucosae, not listed elsewhere" (B08). Analysis of the epidemiological position in the Czech Republic in 1993-1995 was based on EPIDAT data, documentation of epidemic of 1993 in the Liberec district and serologically confirmed minor epidemics (1994, 1995). An increased number of cases (in particular in late winter and early spring) is observed in several years' (cca four-year) cycles and only in some districts. Children aged 3-10 years (88.2%) are affected predominantly. All the year round however sporadic cases affecting people of all age groups are notified. Concurrent illness of several family members (usually two) was confirmed by laboratory tests only in 9 of cca 200 investigated cases. The source of infection is usually not identified. The increase in the number of cases in a given locality rose rapidly after brief time intervals. The longest interval between two cases was 24 days. In families all affected members contracted the disease with 24 hours. According to the seroprevalence of the IgG parvovirus B 19 in different age groups the majority of cases in subadult and adult subjects is not diagnosed and notified. Seroprevalence of IgG antibodies of the parvovirus B 19 in subjects with arthropathies was 72.4%, in subjects with suspect borreliosis 69.9% an in the normal population cca 50%.

[Parvovirus B 19 in pregnancy]. / Parvovirus B 19 v tehotenství.

The human parvovirus B 19 was discovered in 1975 by Cossart but its etiological association with erythema infectiosum and hydrops of the foetus was proved only in 1984-1985. The objective of the submitted prospective study was to assemble basic findings on the herd immunity of the female population and the risk of infection with this agent during pregnancy. Seropositivity of women of fertile age before the epidemic of parvovirus B 19 in 1993 and 1994 was cca 50%, after the epidemic 70%. Erythema infectiosum is a childhood disease (96% of the cases are children under 14 years of age), but seroprevalence of parvovirus IgG in these age groups is only 11%. Thus the infection in adults is frequent but not diagnosed. A parvovirus etiology of possible loss of the foetus on the basis of serological examination is encountered only exceptionally. The Czech commercial preparation gammaglobulin can be used for prevention and treatment of a non-immune foetal hydrops.

[Seroprevalence of IgG antibodies against parvovirus B19 in the population of the Czech Republic]. / Séroprevalence protilátek trídy IgG proti parvoviru B 19 v populaci Ceské republiky.

The human parvovirus B 19 was discovered in 1975 by Cossart in England. Later (1984) evidence was provided that this virus is the etiological agent of erythema infectiosum and hydrops foetalis, and in 1985 it was provided that it is also the etiological agent of some types of arthritis or arthropaties and vasculitis. The diagnosis of the disease caused by this agent is most frequently based on evidence of specific immunoglobulins. The epidemiological and clinical impact of parvoviral infections in the Czech Republic was not known so far. Examination of sera from 562 subjects aged 0-60 years assembled in 1992 in three Czech regions revealed in children, age 0 - 4 years 9.8%, during preschool and school age 27 - 35.7% and in age groups above 15 years a 53.3 - 57.7% seroprevalence of IgG parvovirus B 19, roughly equally distributed among both sexes. The more frequent prevalence of specific immunoglobulins was proved in small groups of female workers in nurseries (66.7%), nursery schools (91.7%) and in blood transfusion stations (77.8%). The seropositivity of the general female population of matched age groups, with the exception of women aged 20 - 24 years, was 53.86%.

[Epidemiology of rabies in the Czech Republic]. / Epidemiologická situace vztekliny v CR.

In 1976 to 1988 on average some 4,323 +/- 482 subjects in the Czech Republic (i.e. 42.6 +/- 7.6/100,000 population) had contact with rabid or suspect animals, i.e. with dogs (73.3%), cats (15.9%), foxes (4.2%), other wild beasts (1.4%) and other animals (6.2%). Data on contact with suspect animals reported from different regions varied greatly. Post-exposition prophylaxis was started on average in 25% of the exposed subjects after contact with dogs in 44.5%, with cats in 24.7%, foxes in 12.6% and with other animals in 18.1% of the treated subjects. Groups of subjects exposed to the same animal (most frequently a cat or dog) or consumption of meat of infected animals accounted for 8% of all vaccinated subjects. During the period between 1974 and 1988 3,852 (22.9%) of exposed 16,845 subjects were treated in anti-rabies centres. From a group of 5,499 subjects 4,013 (73.0%) were injured: 1203 (21.9%) by a known (296, i.e. 5.4% by a rabid) and 2,810 (51.1%) by an unknown animal and the remainder of 1,486 subjects were exposed to suspect animals without being injured--in 1,154 cases (21.0%) to a known (958, i.e. 17.4% positive) and in 232 cases (6.0%) to unknown animals. Foxes accounted in indication for post-exposure prophylaxis for less than 10% and injured only for 1.1% of the vaccinated subjects. In anti-rabies centres most frequently subjects of productive age (44.7%) and school age (24.8%) were treated. The male/female ration was 3:2. Prophylaxis was started within 48 hours after exposure in 45% of the subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Antigenic variation in rabies virus strains.

Several rabies virus isolates from small wild rodents, one strain isolated from a fox and another from a cat, as well as the CVS strain were compared in cross-protection and virus-neutralization tests. Antigenic variations between the strains and between different batches of individual strains were found. These antigenic differences could not be explained by denaturation caused by UV irradiation or deep-freeze storage, by the presence of "incomplete" particles or by passage in immune organism. An antigenic difference was batch-specific and was only demonstrable on comparison with a relatively large number of strains: it has probably developed during the assembly of antigenic determinants of the virion. There was no correlation between protective and virus-neutralizing activities.

Experimental chemotherapy of rabies. Preliminary results.

The effect of 17 immunosuppressive, cytostatic or antiviral agents on the course of illness in weanling conventional mice infected intracerebrally (i.c.) or intramuscularly (i. m.) with lethal or sublethal doses of rabies virus strains isolated from fox and small wild rodents was studied. Potentiation or suppression of virulence by the same compound with some virus strains depended on the route of infection. The best protective effect on i.c. and i. m. infections was achieved with iododeoxyuridine (IUdR) and Actinomycin D on i.c. and with 6-azacytidine and Imuran on i.m. infections, respectively.

Small wild rodents rabies in Czechoslovakia.

During a period of 1969-1979 a total of 3174 small wild rodents of the genus Muridae and Microtinae (predominantly Microtus arvalis) were examined. The animals were trapped in five localities differing both in type of ecological conditions and epizootologic situation. Fox-rabies occurred here either enzootically, or epizootologically, or had been completely absent for many years in one of the localities investigated. Of the 71 isolated strains of RV 18 strains were isolated from brain, 25 from brown fat and 28 from salivary glands. Simultaneous isolation positivity in more than one tissue was sporadic. Virus isolations from deep-frozen material were mostly unsuccessful. Basic biological characteristics were determined in each isolate. The isolated strains differed in the rate of adaptation on albino mice and in intracerebral virulence. All isolates exhibited extraneural pathogenicity for common laboratory animals, dogs and foxes, showed distinct viscerotropism, stimulated formation of interferon and produced various forms of non-lethal infection. Incidence of "murine" rabies did not show any locality-specific differences and in longitudinally studied areas was enzootic. In a number of Czech districts there was observed a distinct relationship between fox-rabies incidence and the density of small game animal populations. Role of small wild rodents in the epizootology and epidemiology of rabies is discussed.

Effect of 9-(S)-(2,3-dihydroxypropyl)adenine on experimental rabies infection in laboratory mice.

9-(S)-(2,3-dihydroxypropyl)adenine (DHPA) exerted a pronounced influence on experimental rabies infection in laboratory mice. It was effective in a dose range from 1 to 100 mg/kg body weight. Intracerebral infection tended to be potentiated, intramuscular infection was partly or fully inhibited by the drug. Peroral administration was the most effective. The results of individual experiments varied and depended on the sensitivity of the virus strains employed, the dose of DHPA given and the time pattern of its administration.

Nonlethal infection of laboratory mice induced with "mouse" rabies strains.

Nonlethal infection was induced in laboratory mice with sublethal doses of rabies strains isolated from small wild rodents. Three types of nonlethal infecion were observed: persistent--with virus irregularly reisolable for at least 56 days after inoculation: latent--with negative virus reisolation but presence of infection demonstrable by transmission of virus neutralization activity to other animals; and abortive--with only a primary immune response, nontransmissible to other animals. A hyperreactive state called "early death" was observed in some mice. All surviving animals recovered without sequelae.

Early events in non-lethal rabies infection.

Inoculation of sublethal doses of rabies virus strains isolated from small wild rodents resulted in non-lethal infection of white mice. During the first 48 hr after inoculation the virus neutralizing and protection activities in mouse sera and brain suspensions increased, followed by a transient decrease on the 3rd and 4th day. In some cases there also occurred transient multiplication of virus, which retained a relatively high infectivity for mice.

Interferon production by rabies strains isolated from wild rodents.

Eight rabies strains isolated from wild rodents produced interferon in laboratory mouse brains the second day after inoculation. Low levels of interferon were also detected in the serum, kidneys and lungs of the animals. The dosage and route of inoculation had no pronounced effect on interferon production.