Norovirus infections in the Czech Republic in 2008-2020.

INTRODUCTION: Noroviruses, together with rotaviruses, are the most common cause of viral gastroenteritis in the Czech Republic (CR). The aim of this study was to analyse data on the incidence of norovirus gastroenteritis in the CR and thus to add to the body of knowledge about its significance. MATERIAL AND METHODS: A descriptive analysis was performed of the basic characteristics of norovirus gastroenteritis reported under ICD-10 code A08.1 to the Epidat or ISIN electronic infectious diseases information system between 2008 and 2020. On the basis of reports from five microbiological laboratories, weekly data on confirmed cases of norovirus infection from 2010-2020 were analysed. Databases of microbiology laboratories from across the Czech Republic were searched to determine the number of the laboratories where norovirus infections were diagnosed and the methods used for this purpose in 2008-2020. RESULTS: From 2008 to 2020, 33,575 cases of norovirus gastroenteritis were reported to the infectious diseases information systems, which equates to an annual incidence of 24.5/100,000 population, varying between years from 8.2 to 77.1/100,000. Men accounted for 40.2% of cases with an incidence of 20.1/100,000 compared to 28.8/100,000 recorded in women. Of the total of reported cases, 14,282 patients (42.5%) required hospital admission. Over the whole study period, 7,431 cases of norovirus gastroenteritis were recorded in children under 5 years of age. This age category accounted for 13.7-38.9% of the annual totals of reported cases. The incidences were 101.8/100,000 in children under 5 years of age, 40.1/100,000 in 5-14-year-olds, 12.7/100,000 in 15-64-year-olds, and 38.2/100,000 in the age group 65 years and over. Twenty-four deaths (case fatality rate of 0.07%) were reported as associated with norovirus gastroenteritis at the ages 42-94. In the age categories 15-64 years and 65 years and over, the case fatality rates were 0.02% and 0.24%, respectively. Over the study period, 274 epidemics occurred, during which 16,893 (50.3%) of the total of 33,575 cases were reported. In the epidemic outbreaks, 1,694 (10.0%) patients required hospital admission. The largest outbreak with 5,248 reported cases in 2015 was associated with contamination of the Prague water supply system. Norovirus infections were laboratory diagnosed year-round, peaking in the autumn and winter months. They are currently diagnosed by 81 laboratories in the Czech Republic, 90.1% of which use immunochromatographic tests. CONCLUSION: The study confirmed the highest incidence of norovirus gastroenteritis among children under 5 years of age and the highest case fatality rate in the age group 65 years and over. Over half of the reported cases were outbreak associated. Most laboratories use immunochromatographic tests. The use of more sensitive laboratory methods would improve diagnosis.

Clostridium difficile infection and colonisation in children under 3 years of age: prospective comparative study.

AIMS: Despite an increasing trend in Clostridium difficile infections (CDI) and high C. difficile colonization rate especially among younger children, infants remain quite resistant to the disease. The goals of this study were to distinguish whether there exists a difference in CDI between children with or without diarrhoea, ascertain the prevalence of CDI, and assess CDI severity in children under 3 years with diarrhoea in our institution. METHODS: A prospective study was conducted from May 2015 to June 2016. Children 3 years of age or younger were enrolled and into two groups. Every faecal sample was tested using a diagnostic two-step screening algorithm including an immunochromatographic test and polymerase chain reaction. RESULTS: The study enrolled 147 children with diarrhoea and 75 control patients. The prevalence of CDI in children with diarrhoea was 2% (3/147), the prevalence of toxigenic C. difficile in the diarrhoeal group compared to the control group was 11.6 % (17/147) vs. 10.6% (8/75) (p.

Clinical and microbiological characteristics of Clostridium difficile infection in children hospitalized at the Departement of Paediatric Infectious Diseases in Brno between 2013 and 2017.

AIMS: Clostridium difficile (C. difficile) plays a minor but important role in paediatrics. The aims of this study were to objectivise data, to show their significance in clinical practice, and to present our experience with the treatment of paediatric patients. MATERIALS AND METHODS: A retrospective study was conducted in patients (0-19 years of age) hospitalized for Clostridium difficile infection (CDI) in the Department of Paediatric Infectious Diseases, University Hospital in Brno between 2013 and 2017. Each patient was tested using a two-step diagnostic screening algorithm including immunochromatography and polymerase chain reaction assays. RESULTS: Thirty-five patients with a median age of 10.3 years (range 1-17.5 years) were enrolled in the study. Almost 70% of patients were aged between 6 and 19 years. No risk factor was identified in one patient, 41.6% of cases were patients with malignancy or inflammatory bowel disease, and 2.5% of patients had short bowel syndrome. After targeted CDI treatment, the median time to resolution of diarrhoea was 2.5 days. Metronidazole was used in more than half of cases. Five patients received fidaxomicin, which was well tolerated. Metronidazole failed in three cases. Recurrence after incomplete treatment with metronidazole occurred in one patient. Health care-associated CDI was recorded in 86% of cases. Recurrent CDI was reported in four children (two with malignancy, one with inflammatory bowel dissease, and one with short bowel syndrome). CONCLUSIONS: The course of CDI is generally mild in the paediatric population. CDI without a risk factor is rare. Paediatric patients respond well to metronidazole. Fidaxomicin was well tolerated by all patients. We prefer the treatment with fidaxomicin in high-risk groups (immunocompromised condition, inflammatory bowel disease, and short bowel syndrome).

[Campylobacteriosis at the Department of Infectious Diseases of the University Hospital Brno in 2011-2013: a retrospective study]. / Kampylobakteriózy na Klinice infekcních chorob Fakultní nemocnice Brno v letech 2011-2013: retrospektivní studie.

OBJECTIVE: To provide basic clinical, laboratory, and microbiological characteristics of adult patients with campylobacteriosis admitted to the Department of Infectious Diseases University Hospital Brno (UHB), in 2011-2013. MATERIALS AND METHODS: A retrospective analysis of clinical and laboratory parameters of 160 patients hospitalized with campylobacteriosis at the Department of Infectious Diseases, UHB from 1 January 2011 to 31 December 2013. RESULTS: There was no lethality or bacteremia reported in the study group of 160 adult patients (n=160) with campylobacteriosis. A more severe form of the disease with signs of systemic inflammatory response syndrome (SIRS) occurred in 24 patients, i.e. 15% of the study population. Transient mild to moderate leukocytopenia and thrombocytopenia were seen in 16 (10.0%) and 24 patients (15.0%), respectively, and seven patients (4.4%) had bicytopenia. The following factors correlated statistically significantly with the intestinal form of the disease and SIRS: age under 70 years (p=0.037), absence of arterial hypertension (p=0.044), immunosuppressive treatment (p=0.008), leukocyte count in the peripheral blood over 12.0×10(9)/l (p=0.023), and body temperature over 38.0 °C (p<0.001). Antibiotic treatment was used in 96.3% of patients with the intestinal form and in 100.0% of patients with SIRS. The average duration of antibiotic treatment was 8.8 and 9.3 days, respectively. Postantibiotic colitis due to Clostridium difficile occurred in seven patients (4.4%). There were no organ or autoimmune complications observed. CONCLUSIONS: Campylobacteriosis with SIRS occurs preferentially in persons under 70 years of age. Empirical antibiotic treatment is used too frequently without being adequately deescalated.

[Infections caused by non-typhi serovars of Salmonella at the Infectious Diseases Clinic of the University Hospital Brno in 2011-2013]. / Infekce zpusobené netyfovými sérovary salmonel na Klinice infekcních chorob Fakultní nemocnice Brno v letech 2011-2013--retrospektivní studie.

INTRODUCTION: The aim of the study is to describe the basic clinical, laboratory, and microbiological characteristics in adult patients with salmonellosis hospitalized at the Infectious Diseases Clinic of the University Hospital Brno in 2011-2013. MATERIALS AND METHODS: A retrospective analysis of clinical and laboratory parameters of 161 patients hospitalized at the Infectious Diseases Clinic of the University Hospital Brno from 1 January 2011 to 31 December 2013. RESULTS: Invasive salmonellosis was seen in 22.4% of the study group. The overall lethality rate reached 3.1%. Treatment with antibiotics was used in 93.8% of patients. Transient mild to moderate leukocytopenia was reported in 4.3% of patients and thrombocytopenia in 9.3% of patients. Transient changes in white blood cells as well as in the thrombocyte count were not clinically important. Long-term treatment with proton pump inhibitors is a risk factor for salmonellosis (p=0.128), but not for invasive salmonellosis. Long-term use of opioids (p=0.003) and/or acetylsalicylic acid (p=0.015) is a risk factor for invasive salmonellosis. Other risk factors for invasive disease are: age over 70 years (p=0.011), arterial hypertension (p=0.004), disease duration of less than three days (p=0.006), serum creatinine level above 250 µmol/l (p=0.01), peripheral leucocyte count above 12x10(9)/l (p=0.001), and body temperature above 38 °C (p=0.001). Hypokalemia does not represent a risk factor for invasive salmonellosis. CONCLUSIONS: Aged patients on long-term opioids or acetylsalicylic acid, with disease duration of less than three days, and meeting the criteria for systemic inflammatory response syndrome are at the highest risk for invasive salmonellosis. Empirical antibiotics are prescribed too often and the treatment is not properly de-escalated.

[Refractive defects of the eye in descendents of a rural population in western Moravia]. / Refrakcní vady oka v descendentních generacích venkovské populace západní Moravy.

The results from longitudinal follow-up of the incidence of refractive eye errors in a population from rural region have contributed to the characteristics of the regional gene pool. Generation born within 1950-1964 (Generation I.) was compared with that born within 1980-1994 (Generation II.). At the same time, a long-term follow-up has demonstrated changes in the quantity of phenotypes in absolute number (values of morbidity: generation I.--all types of refractive errors: urban population men 104/1000, women 132/1000. Rural population men 119/1000, women 135/1000. Generation II.: urban men 132/1000, women 169/1000, rural men 124/1000, women 136/1000. The difference in morbidity between women and men in the Ist and IInd generations, both urban and rural, has not changed. A more pronounced difference can be seen in urban population, namely at myopia in both generations (myopia urban population: generation I. men 40.8%, women 59.2%, generation II. men 43.9%, women 56.1%, myopia rural population: generation I.: men 44.2%, women 55.8%, generation II.: men 47.2%, women 52.8%. Hyperopia urban population: generation I., men 46.7%, women 53.3%, generation II. men 47.3%, women 52.7%. The incidence of astigmatism has shown constant ratio 1:1 both between men and women, and urban and rural populations. These changes were demonstrated most markedly in urban population, but these deviations are caused by emigration from rural to urban districts, especially from a hinterland. 10% of IInd generation (1980-1994) are relatives of Ist generation (1950-1964) only.

Variability of chromosomes in the VUP permanent cell line derived from uveal malignant melanoma.

A permanent cell line [VUP] derived 31 years ago from human malignant melanoma of the choroid has been characterized by genetically firmly anchored heteronuclearity. The most significant chromosomal changes of this cell line are: high instability of the chromosome No. 13 with the rise of new chromosomes formed by translocations, homologous stability of chromosomes 6, 15, and X. Structural changes were not revealed in chromosomes 15 and 22. The variability of chromosomes was studied both by classical conventional methods as well as with GTG banding and DNA hybridization in situ (FISH). Structural diversity was demonstrated in a number of morphologically congruent chromosomes. For example, X chromosome classified morphologically as chromosome No. 10 was determined by means of FISH technique, as a centric fragment Xq with translocated acentric fragment of other chromosomes. Furthermore, mar-t, previously considered to be q arm of chromosome No. 4, is formed by a centric fragment of chromosome No. 13 and an acentric fragment of chromosome No. 1.

[Assortative mating among individuals with refractive errors of the eye]. / Asortativnost v uzavírání partnerství mezi postizenými refrakcními vadami ocí.

Negative assortative mating for refractive errors of the eyes of 1241 married couples was discovered in the urban region of the South Moravian region. 46 married couples were myopic, 55 hyperopic, 73 astigmatic, 175 had combinations of refractive errors, 261 were emetropic and 631 were mixed. Negative assortative mating is highly significant (chi-square P < or = 0.001). It is more significant for urban population. Positive selection for emetropic married couples plays more important role in urban peoples than in citizens.

HDR intraluminal brachytherapy in the treatment of malignant bronchial obstructions.

Symptomatology of malignant intrabronchial obstructions has a serious negative effect on the quality of patients' life. Intrabronchial brachytherapy can play an important role in the palliation of these symptoms. Between December 1996 and September 1998 48 patients suffering from malignant intrabronchial obstructions were treated with intraluminal brachytherapy in the Dept. of Radiation Oncology at the University Maternity Hospital in Brno. Gammamed HDR automatical afterloading equipment was used to treat all patients. The first group (23 patients) was treated with a combination of intraluminal brachytherapy and external radiotherapy. The second group (18 patients who had relapsed after previous external radiotherapy) was given intraluminal radiotherapy only. A third group (7 patients) underwent intraluminal brachytherapy only. In the first group 17 patients (77%) showed symptomatic relief with tumor regression on X-ray in 16 patients and with bronchoscopic regression in 19 patients. Seven patients died before October 1998 having survived 1-6 months after the first brachytherapy application. Sixteen patients are still alive (1-14 months). In the second group, 10 patients (56%) reported significant improvement of symptoms, with endoscopic regression in 12 patients. Twelve patients died before October 1998 surviving 1-6 months after the first brachytherapy session, 6 patients are still alive 1-5 months after the first brachytherapy fraction. In the third group, bronchoscopy confirmed a complete disappearance of intrabronchial lesion in two cases with early intrabronchial tumor. Five patients reported symptomatic improvement with endoscopic regression of the tumor. There was only one complication recorded: bronchospasm in one patient. The short follow up and limited number of patients does not allow comment on the late effects and survival, yet. In conclusion, intraluminal brachytherapy is an effective and safe approach for palliation of malignant bronchial obstructions.

[Secondary myelodysplastic syndrome in a boy with non-Hodgkin's lymphoma]. / Sekundární myelodysplastický syndrom u chlapce s NH lymfomem.

The authors describe the case-history of a boy with secondary myelodysplastic syndrome (MDS) which developed into acute leukaemia. The latter was quite resistant to treatment. The disease was preceded by treatment of NH lymphoma with a high grade of malignity by radiotherapy and chemotherapy. The authors give the total doses of all cytostatics which were administered to the patient. One year prior to diagnosis of MDS cytogenetic examination of peripheral blood revealed a highly pathological karyotype, from the numerical and structural aspect. Among others monosomy of chromosome no. 5 was found which is typical for MDS and these changes indicate as a rule a poor prognosis and relatively early transformation to acute leukaemia.

[Mesodermal dysgenesis]. / K problematice mezodermální dysgeneze.

The authors present an account on a 12-year-old girl with ectomesodermal dysgenesis of the Rieger type syndrome. The disease was manifested at the age of nine months by transient diffuse corneal opacity, while the intraocular pressure was normal. In addition to typical corneal changes and changes in the angle of the chamber other associated somatic symptoms included megalocornea, high myoptic astigmatism, cleft soft palate, hypoplasia of the upper jaw, partial anodontia, marked thoracic kyphosis, scoliosis, generalized hypermobility and taxicity of the joints and torticollis. Examination revealed an uncommon pathological karyotype 46, XX, t/1,4 (p36, q23). Cytogenetic examination of the parents and siblings of the proband did not disclose any numerical or structural aberrations. The authors reflect on possible causes of the development of the disease and on the differential diagnosis.

Multiple tumors in gynecology.

Two large groups of patients, i.e. 1893 patients treated at the Institute for carcinoma cervicis uteri and 1184 patients with Ca corporis uteri were selected and evaluated for a follow-up study and statistical processing of tumor duplicity of gynecological origin. Double tumor in the group with Ca cervicis uteri was found in 88 women, i.e. 4.6%, and in that treated for Ca corporis uteri in 85, i.e. 7.2% of the patients. The most frequent combination in the two groups of carcinoma is breast cancer amounting to 28.4% in Ca cervicis uteri and to 35.3% in Ca corporis uteri. The second most frequent primary carcinoma in Ca cervicis uteri is dermal carcinoma--23.9%, and in Ca corporis uteri that of the digestive tract--21.1%. A statistical follow-up over 40 years indicates a rise in tumor duplicity in both groups of gynecological carcinoma--cervical and endometrial, with the number in the former having increased more than twofold.

Human melanoma cell lines: morphology, growth, and alpha-mannosidase characteristics.

Four human melanoma cell lines were characterized by evaluation of the morphology, ultrastructure, cytogenetics, plating efficiency, agar colony formation and alpha-mannosidase values. Biochemical studies demonstrate that all studied lines produced alpha-mannosidase even under condition of long-term in vitro growth. All respective lines were characterized by a great variations in biological markers studied and very few reliable comparisons could be obtained as regards the proliferation activity and capacity, cellular composition and clonogenic potential as well. Due to cellular selections during long-term in vitro cultivation, the range for using these experimental systems as models for the study of biology of human malignant melanoma seems to be rather limited.

Clastogenicity and sister chromatid exchange induction by ftorafur.

The main effect of Ftorafur at the chromosomal level is the induction of chromatid and chromosome breaks, which is some pronounced in neoplastic or transformed cells than in normal cells. Different cell lines used in the study exhibited both in vitro and in vivo varying sensitivity to Ftorafur. Ftorafur does not increase the frequency of SCE.