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OBJECTIVE: This article aims to conduct a comparison of swimming performance during short course national championships (25-m) from 2019 and 2020 (before and during the pandemic). MATERIALS AND METHODS: The data points from the championships will be compared for 5 European countries: Poland, Spain, Russia, Turkey, and Denmark. Times achieved in the finals were calculated by the analysis of variance. Post hoc pairwise comparison analysis was performed using Tukey's test. The analysis plan included the assessment of the main effects and the effect of interactions in the groups of women and men. The strength of the effect was expressed by the partial eta-squared ratio. RESULTS: Two main trends were observed in the results. The first was a greater variation in the results in the group of men than in women (12-5 differences). The second was the development and improvement of sports performance in symmetrical strokes (69% improvement in recorded times measured during the pandemic, e.g., in Poland, women on 50-m breaststroke and butterfly Δ = 0.52, p <0.001 and Δ = 0.32, p = 0.034, men on 50-m and 100-m butterfly Δ = 0.34, p = 0.003 and Δ = 1.21, p <0.001). CONCLUSIONS: The main conclusion of our analysis is that the pandemic influenced the development of sports performance in symmetrical techniques, i.e., in breaststroke and butterfly.
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Rendimiento Atlético , COVID-19 , COVID-19/epidemiología , Femenino , Humanos , Masculino , Pandemias , España , NataciónRESUMEN
AIMS: To present our experience with pre-exposure prophylaxis (PrEP) at the HIV Center of the Military University Hospital Prague, to characterize a set of PrEP candidates, to assess the efficiency and safety of PrEP and to measure the incidence of sexually transmitted diseases (STDs) in the studied cohort. MATERIAL AND METHODS: In total, 99 PrEP candidates (98 men who have sex with men and one woman) were monitored during an 18-month period. An initial examination included acquiring a history, performing a physical examination, screening for HIV (serology) and other STDs and performing renal function tests. RESULTS: In total, 81 candidates (in the cohort of 99 candidates) received PrEP. During the course of the 18-month period, none of the clients were newly infected with HIV, and no side effects of the provided medication were recorded. A total of 21% of the 99 PrEP candidates were initially tested positive for STDs, including two clients with HIV. A total of 14% of the 81 PrEP clients contracted an STD during the monitoring period. CONCLUSIONS: Experience amassed at the HIV Center of the Military University Hospital Prague over an 18-month period documented the demand for PrEP, assessed PrEP efficacy, indicated good tolerance and suggested that PrEP played a role in the decline in the HIV incidence in the Czech Republic. In addition, several new HIV cases and cases of other asymptomatic STDs were also detected.
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Infecciones por VIH , Hospitales Militares , Personal Militar , Profilaxis Pre-Exposición , República Checa , Femenino , Infecciones por VIH/prevención & control , Homosexualidad Masculina/estadística & datos numéricos , Hospitales Militares/estadística & datos numéricos , Humanos , Masculino , Minorías Sexuales y de Género/estadística & datos numéricosRESUMEN
AIMS: To process data from the first wave of Covid-19 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) collected in the Infectious Diseases Clinic (IDC) of the First Faculty of Medicine and Central Military Hospital, Prague. To analyse some clinical, diagnostic and therapeutic aspects of Covid-19 in the context of the Czech Republic and to compare them with the data from the most recent literature. PATIENTS AND METHODS: This retrospective study analysed data on patients admitted to the IDC between 12 March 2020 and 5 May 2020. The study cohort included 53 patients with Covid-19, 25 females and 28 males, with an average age of 57 years. The parameters analysed were clinical symptoms, average length of hospital stay, complications, and death. Additional data concerned the age, weight, smoking habits, history of comorbidities, and selected laboratory results. These data were compared between groups of patients differing in severity of the course of Covid-19. Finally, imaging findings, serology results, and therapy outcomes were studied. Statistical analysis was performed using the SigmaStat software. RESULTS: Eleven (20.8%) patients had a mild course of the disease, 16 (30.2%) patients had a moderate course, 22 (41.5%) patients had a severe course, and four (7.5%) patients had a critical course. The study patients presented with the following clinical symptoms: fever in 88.5% of cases, cough in 84.6% of cases, difficulty breathing in 77.4% of cases, diarrhoea in 23.1% of cases, chest pain in 17.3% of cases, and anosmia in 11.5% of cases. The average length of hospital stay was eight days. The most common complication was a bacterial superinfection, reported in 17 (32.1%) study patients. The overall case fatality rate for Covid-19 in our study was 5.7%. The average age of the study cohort was 57 years, and patients with a severe course of the disease were of older average age than those with a less severe course of the disease (p < 0.05). The predominant comorbidities were hypertension and diabetes mellitus. The analysis of the baseline laboratory data showed significant differences between the groups of patients differing in severity of the course of Covid-19 in CRP, procalcitonin, and d-dimers but not in lymphocyte count. High resolution computed tomography (HRCT) scan of the lungs was performed in 22 patients, and 21 of them had typical findings for Covid-19. The average MuLBSTA score for Covid-19 pneumonia severity in our study cohort was 11.5 points and was not associated with the severity of the course of the disease. Serology tests were performed in 43 study patients, with 29 (67.4%) of them turning out positive in the first test and other five (11.6%) testing positive when retested. Hydroxychloroquine (HCQ) was given experimentally as monotherapy or in combination with azithromycin (AZI) to 24 (45.3%) patients. Two patients on HCQ therapy also received inosinum pranobexum (isoprinosine) for severe lymphopenia, one patient received convalescent plasma, six patients were given AZI alone, and one patient was treated with inosinum pranobexum alone. Altogether 37.7% of study patients were prescribed other antibiotics for confirmed or suspected bacterial superinfection. Standard clinical and pharmaceutical care was provided to patients with particular focus on the safety of off-label drug use. HCQ was with drawn in three patients due to a prolonged corrected QT interval (QTc). CONCLUSIONS: In the first wave of the SARS-CoV-2 epidemic, our study patients showed comorbidities and risk factors which are consistent with the international literature, but the course of the disease was mostly moderate to severe, with a low proportion of critically ill patients and fatal outcomes. As soon as new information became available, new diagnostic and therapeutic options were introduced into routine practice. Based on our experience, we are well prepared for a possible second wave of SARS-CoV-2 in terms of the diagnostics, but the therapeutic options still remain very limited.
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COVID-19/epidemiología , COVID-19/diagnóstico , COVID-19/terapia , República Checa/epidemiología , Femenino , Hospitales Militares , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Estados UnidosRESUMEN
BACKGROUND: Acute hepatitis B (AHB) can run a severe course, which sometimes leads to a fulminant disease with acute liver failure (ALF). Pro-coagulation factors are well-established markers of AHB severity, but less is known about the levels of anti-coagulation parameters in AHB. METHODS: In this study, we demonstrate that antithrombin (AT) plasma levels were associated with AHB severity in 161 patients. RESULTS: Nine (6%) patients had severe AHB (i.e. international normalized ratio [INR] ≥ 1.6 and total bilirubin ≥ 10 mg/dL). Coagulopathy (i.e. INR > 1.2 and/or AT < 80%) was observed in 65 (40%) AHB patients on admission. Low initial plasma AT levels (i.e. < 80%) were observed in 56 (35%) patients. In all, plasma AT levels decreased in 91 (57%) patients during their hospital stay. Both baseline and nadir AT levels were significantly lower in severe than in mild and moderate AHB. Moreover, the concentration of AT negatively correlated with INR, aspartate aminotransferase, and total and conjugated bilirubin levels. Interestingly, nadir AT levels positively correlated with the duration of hospitalization. CONCLUSIONS: These results indicate that plasma AT levels can be used as an additional marker of AHB severity.
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Antitrombinas/sangre , Hepatitis B/diagnóstico , Enfermedad Aguda , Adulto , Anciano , Anciano de 80 o más Años , Biomarcadores/sangre , Femenino , Humanos , Masculino , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , Adulto JovenRESUMEN
Staphylococcus aureus bacteremia (SAB) is the most common cause of severe bloodstream infections with high incidence and lethality. The diagnosis of SAB must be followed by an appropriate diagnostic and therapeutic management. The aim of the study was to identify clinical and epidemiological characteristics of SAB cases treated in the Central Military Hospital Prague and to assess compliance with the guidelines for diagnosis and thera-py. A total of 65 patients with S. aureus blood culture positivity were enrolled in the retrospective study. Sixty SAB cases (92%) were caused by MSSA strains, and MRSA strains were detected in five patients (8%). The source of the infection was confirmed in 83% of patients. The average case fatality rate in the study cohort was 28%. The analysis of the quality of care suggested both diagnostic and therapeutic insufficiencies in 65% of SAB patients. Overall, the result of the study supports the importance of the role of infectious disease specialists played in the bedside management of patients with SAB.
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Bacteriemia , Infección Hospitalaria , Infecciones Estafilocócicas , Staphylococcus aureus , Bacteriemia/diagnóstico , Bacteriemia/microbiología , Bacteriemia/mortalidad , Infección Hospitalaria/diagnóstico , Infección Hospitalaria/microbiología , Infección Hospitalaria/mortalidad , Humanos , Estudios Retrospectivos , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/microbiología , Infecciones Estafilocócicas/mortalidad , Staphylococcus aureus/fisiologíaRESUMEN
Sepsis is a life-threatening condition caused by a dysregulated host response to infection. Over the last decades, the approach to sepsis is evolving dramatically, mainly as a result of a rapid increase in the knowledge of its epidemiology, physiopathology, and management. In this context, the new international criteria and definition for sepsis, The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3), were introduced in 2016. The criteria were established consensually by the Task Force which consisted of experts from the Society of Critical Care Medicine and the European Society of Intensive Care Medicine. The main goal is the expansion of awareness of the professional public about this medical condition with a high fatality rate, particularly when not diagnosed and treated early. Sepsis-3 should also serve as a benchmark for future preclinical and clinical research, development of new diagnostic methods, and the terapy of patients with sepsis and septic shock.
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Sepsis , Terminología como Asunto , Comités Consultivos , Consenso , Humanos , Choque SépticoRESUMEN
The redox state of cellular exofacial molecules is reflected by the amount of available thiols. Furthermore, surface thiols can be considered as indicators of immune cell activation. One group of thiol containing proteins, peroxiredoxins, in particular, have been associated with inflammation. In this study, we assessed surface thiols of the U937 and Thp1 monocyte cell lines and primary monocytes in vitro upon inflammatory stimulation by irreversibly labelling the cells with a fluorescent derivative of maleimide. We also investigated exofacial thiols on circulating blood mononuclear cells in patients with rheumatoid arthritis and healthy controls. When analysing extracellular vesicles, we combined thiol labelling with the use of antibodies to specific CD markers to exclude extracellular vesicle mimicking signals from thiol containing protein aggregates. Furthermore, differential detergent lysis was applied to confirm the vesicular nature of the detected extracellular events in blood plasma. We found an increase in exofacial thiols on monocytes upon in vitro stimulation by LPS or TNF, both in primary monocytes and monocytic cell lines (p<0.0005). At the same time, newly released extracellular vesicles showed a decrease in their exofacial thiols compared with those from unstimulated cells (p<0.05). We also found a significant elevation of surface thiols on circulating monocytes in rheumatoid arthritis patients (p<0.05) and newly released extracellular vesicles of isolated CD14+ cells from rheumatoid arthritis patients had decreased thiol levels compared with healthy subjects (p<0.01). Exofacial peroxiredoxin 1 was demonstrated on the surface of primary and cultured monocytes, and the number of peroxiredoxin 1 positive extracellular vesicles was increased in rheumatoid arthritis blood plasma (p<0.05). Furthermore, an overoxidised form of peroxiredoxin was detected in extracellular vesicle-enriched preparations from blood plasma. Our data show that cell surface thiols play a protective role and reflect oxidative stress resistance state in activated immune cells. Furthermore, they support a role of extracellular vesicles in the redox regulation of human monocytes, possibly representing an antioxidant mechanism.
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Artritis Reumatoide/metabolismo , Membrana Celular/metabolismo , Vesículas Extracelulares/metabolismo , Inflamación/metabolismo , Monocitos/fisiología , Compuestos de Sulfhidrilo/metabolismo , Adulto , Anciano , Anciano de 80 o más Años , Membrana Celular/química , Femenino , Humanos , Lipopolisacáridos/inmunología , Masculino , Maleimidas , Persona de Mediana Edad , Oxidación-Reducción , Estrés Oxidativo , Compuestos de Sulfhidrilo/química , Células THP-1 , Factor de Necrosis Tumoral alfa/metabolismo , Células U937RESUMEN
A case history is presented of a 35-year-old man admitted to the hospital with tuberculous meningitis complicated by caseous necrosis of cervical lymph nodes and thrombosis of the left jugular vein. Another complication, malignant brain edema, appeared more than one year after discharge from hospital and was managed at the neurosurgery department. The most probable cause was a post-inflammatory obstruction of the cerebrospinal fluid pathways. A challenging finding, observed repeatedly while in hospital and at follow ups after discharge, was medium significant CD4+ T cell lymphopenia, with the lowest CD4+ T cell count of 308 cells/µl of peripheral blood. For this reason, the patient was screened several times for anti-HIV antibodies, but always with a negative result. Active tuberculous infection was considered as another possible reason behind persistent CD4+ T cell lymphopenia. However, imaging and laboratory analyses were not suggestive of tuberculosis. The patient is currently in good condition and his CD4+ T lymphocyte counts returned to normal at seven years of follow-up. It is underlined that patients after tuberculous meningitis need a long-term follow-up.
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Recuento de Linfocito CD4 , Linfocitos T CD4-Positivos/inmunología , Linfocitopenia-T Idiopática CD4-Positiva/diagnóstico , Tuberculosis Meníngea/diagnóstico , Adulto , Humanos , Ganglios Linfáticos , Linfopenia , Masculino , Linfocitopenia-T Idiopática CD4-Positiva/complicaciones , Tuberculosis Meníngea/inmunologíaRESUMEN
To determine changes in incidence of reactivation of Toxoplasma gondii infection, manifesting as toxoplasmic encephalitis, and to assess the immunological mechanisms controlling reactivation in HIV-infected patients, a Czech cohort of 502 HIV/T. gondii co-infected patients was followed for 2909·3 person-years. The incidence of toxoplasmic encephalitis between the periods before and after the introduction of combination antiretroviral therapy (cART) was compared. Toxoplasmic encephalitis was diagnosed in 21 patients. In those patients the geometric mean value of CD4+ T lymphocytes was 12·6 times lower than in patients with non-reactivated T. gondii infection but an additionally significant decline in CD8+ T lymphocytes (3·3-fold) and natural killer cells (4·3-fold) was observed. This confirms the significance of these parameters. A twelvefold decrease in Toxoplasma reactivation incidence (40·2 vs. 3·4/1000 person-years) between monitored periods was seen. In the cART era, Toxoplasma reactivation was observed only in patients with unrecognized HIV infection or refusing therapy.
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Infecciones por VIH/complicaciones , Toxoplasma/aislamiento & purificación , Toxoplasmosis Cerebral/epidemiología , Toxoplasmosis Cerebral/patología , Adulto , Recuento de Linfocito CD4 , Linfocitos T CD8-positivos/inmunología , Estudios de Cohortes , República Checa , Femenino , Infecciones por VIH/inmunología , Humanos , Incidencia , Células Asesinas Naturales/inmunología , Masculino , Persona de Mediana EdadRESUMEN
The pathogenesis of hepatitis C virus (HCV) infection is regulated by the host immunity and several metabolic factors affecting liver metabolism, including oxidative stress, insulin resistance, and hepatic steatosis. Both innate and adaptive immunity play an important role in HCV infection. Cytotoxic lymphocytes have a crucial role in viral eradication or viral persistence. Major cause of viral persistence during HCV infection could be the development of a weak antiviral immune response to the viral antigens, with corresponding inability to eradicate infected cells.
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Hepacivirus/inmunología , Hepatitis C/inmunología , Animales , Hepacivirus/genética , Hepacivirus/patogenicidad , Hepatitis C/virología , Humanos , Linfocitos T Citotóxicos/inmunologíaRESUMEN
The authors present an up-to-date review of toxic shock syndrome (TSS) - a life-threatening condition where toxins of the Gram-positive bacteria Staphyloccocus aureus and Streptococcus pyogenes play a key role in the pathogenesis. The authors provide insight into the epidemiology and pathogenesis of the disease and point out the relevant patient history data and clinical signs and symptoms that may indicate progression of TSS. Last but not least, the state of the art diagnostic and therapeutic approaches to early and full blown TSS are summarized. Case reports are presented to illustrate two different etiological forms of this relatively rare nosological entity.
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Toxinas Bacterianas/toxicidad , Choque Séptico/microbiología , Infecciones Estafilocócicas/microbiología , Infecciones Estreptocócicas/microbiología , Animales , Toxinas Bacterianas/metabolismo , Humanos , Choque Séptico/tratamiento farmacológico , Infecciones Estafilocócicas/tratamiento farmacológico , Staphylococcus aureus/metabolismo , Infecciones Estreptocócicas/tratamiento farmacológico , Streptococcus pyogenes/metabolismoRESUMEN
Early diagnosis of severe infectious diseases is essential for timely implementation of lifesaving therapies. In a search for novel biomarkers in sepsis diagnosis we focused on polymorphonuclear neutrophils (PMNs). Notably, PMNs have their protein cargo readily stored in granules and following systemic stimulation, an immediate increase of neutrophil-borne proteins can be observed into the circulation of sepsis patients. We applied a combination of mass spectrometry (MS) based approaches, LC-MS/MS and selected reaction monitoring (SRM), to characterise and quantify the neutrophil proteome in healthy or disease conditions. With this approach we identified a neutrophil-derived protein abundance pattern in blood plasma consisting of 20 proteins that can be used as a protein signature for severe infectious diseases. Our results also show that SRM is highly sensitive, specific, and reproducible and, thus, a promising technology to study a complex, dynamic and multifactorial disease such as sepsis.
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Proteínas Sanguíneas/metabolismo , Cromatografía Liquida , Neutrófilos/metabolismo , Proteómica/métodos , Sepsis/sangre , Espectrometría de Masas en Tándem , Biomarcadores/metabolismo , Estudios de Casos y Controles , Progresión de la Enfermedad , Humanos , Neutrófilos/inmunología , Neutrófilos/microbiología , Valor Predictivo de las Pruebas , Sepsis/diagnóstico , Sepsis/inmunología , Sepsis/microbiología , Índice de Severidad de la EnfermedadRESUMEN
The identification of an ultra-high risk (UHR) profile for psychosis and a greater understanding of its prodrome have led to increasing interest in early intervention to delay or prevent the onset of psychotic illness. In a randomized placebo-controlled trial, we have identified long-chain ω-3 (ω-3) polyunsaturated fatty acid (PUFA) supplementation as potentially useful, as it reduced the rate of transition to psychosis by 22.6% 1 year after baseline in a cohort of 81 young people at UHR of transition to psychosis. However, the mechanisms whereby the ω-3 PUFAs might be neuroprotective are incompletely understood. Here, we report on the effects of ω-3 PUFA supplementation on intracellular phospholipase A2 (inPLA(2)) activity, the main enzymes regulating phospholipid metabolism, as well as on peripheral membrane lipid profiles in the individuals who participated in this randomized placebo-controlled trial. Patients were studied cross-sectionally (n=80) and longitudinally (n=65) before and after a 12-week intervention with 1.2 g per day ω-3 PUFAs or placebo, followed by a 40-week observation period to establish the rates of transition to psychosis. We investigated inPLA(2) and erythrocyte membrane FAs in the treatment groups (ω-3 PUFAs vs placebo) and the outcome groups (psychotic vs non-psychotic). The levels of membrane ω-3 and ω-6 PUFAs and inPLA(2) were significantly related. Some of the significant associations (that is, long-chain ω-6 PUFAs, arachidonic acid) with inPLA(2) activity were in opposite directions in individuals who did (a positive correlation) and who did not (a negative correlation) transition to psychosis. Supplementation with ω-3 PUFA resulted in a significant decrease in inPLA(2) activity. We conclude that ω-3 PUFA supplementation may act by normalizing inPLA(2) activity and δ-6-desaturase-mediated metabolism of ω-3 and ω-6 PUFAs, suggesting their role in neuroprogression of psychosis.
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Ácidos Grasos Omega-3/farmacología , Fosfolipasas A2/efectos de los fármacos , Trastornos Psicóticos/metabolismo , Adolescente , Adulto , Estudios Transversales , Progresión de la Enfermedad , Método Doble Ciego , Membrana Eritrocítica/efectos de los fármacos , Membrana Eritrocítica/metabolismo , Ácidos Grasos Omega-3/uso terapéutico , Ácidos Grasos Omega-6/metabolismo , Femenino , Humanos , Líquido Intracelular/efectos de los fármacos , Líquido Intracelular/metabolismo , Estudios Longitudinales , Masculino , Fosfolipasas A2/sangre , Trastornos Psicóticos/dietoterapia , Factores de Riesgo , Adulto JovenAsunto(s)
Membrana Eritrocítica/metabolismo , Ácidos Grasos Monoinsaturados/sangre , Trastornos Psicóticos/sangre , Adolescente , Biomarcadores/sangre , Humanos , Valor Predictivo de las Pruebas , Trastornos Psicóticos/diagnóstico , Ensayos Clínicos Controlados Aleatorios como Asunto/psicología , Factores de RiesgoRESUMEN
PURPOSE: Timely knowledge of the bacterial etiology and localization of infection are important for empirical antibiotic therapy. Thus, the goal of this study was to evaluate routinely used biomarkers together with novel laboratory parameters in the diagnosis of infection. METHODS: In this prospective study, 54 adult patients with bacterial infections admitted to the Department of Infectious Diseases were included. For comparison, 27 patients with viral infections were enrolled. In these patients, white blood cell (WBC) counts, differential blood counts, serum levels of procalcitonin (PCT), IL-1ß, IL-6, IL-8, IL-10, IL-12, TNF-α, IFN-γ, soluble CD14 (sCD14), heparin-binding protein (HBP), cortisol (Cort), and monocyte surface expression of TLR2, TLR4, HLA-DR, and CD14 were analyzed. Also, these biomarkers were evaluated in 21 patients with acute community-acquired bacterial pneumonia (CABP), as well as in 21 patients with pyelonephritis and urosepsis. RESULTS: The highest sensitivity and specificity (expressed as the area under the curve [AUC]) for bacterial infection were observed in serum concentration of PCT (0.952), neutrophil and lymphocyte counts (0.852 and 0.841, respectively), and serum levels of HBP (0.837), IL-6 (0.830), and Cort (0.817). In addition, the serum levels of IFN-γ and Cort were significantly higher and IL-8 levels were lower in CABP when compared to pyelonephritis or urosepsis. CONCLUSIONS: From the novel potential biomarkers, only PCT demonstrated superiority over the routine parameters in the differentiation of bacterial from viral infections. However, some of the novel parameters should be further evaluated in larger and better characterized cohorts of patients in order to find their clinical applications.
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Infecciones Bacterianas/diagnóstico , Calcitonina , Precursores de Proteínas , Virosis/diagnóstico , Adulto , Infecciones Bacterianas/sangre , Biomarcadores , Calcitonina/sangre , Péptido Relacionado con Gen de Calcitonina , Infecciones Comunitarias Adquiridas/sangre , Infecciones Comunitarias Adquiridas/diagnóstico , República Checa , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Prospectivos , Precursores de Proteínas/sangre , Pielonefritis/sangre , Pielonefritis/diagnóstico , Sensibilidad y Especificidad , Sepsis/sangre , Sepsis/diagnóstico , Índice de Severidad de la Enfermedad , Sistema Urinario/microbiología , Virosis/sangreRESUMEN
Innate immune surveillance in the blood is executed mostly by circulating monocytes, which recognise conserved bacterial molecules such as peptidoglycan and lipopolysaccharide. Toll-like receptors (TLR) play a central role in microbe-associated molecular pattern detection. Here, we compared the differences in TLR expression and cytokine production after stimulation of peripheral blood cells with heat-killed Gram-negative and Gram-positive human pathogens Neisseria meningitidis, Escherichia coli, Staphylococcus aureus and Streptococcus pneumoniae. We found that TLR2 expression is up-regulated on monocytes after stimulation with S. aureus, S. pneumoniae, E. coli and N. meningitidis. Moreover, TLR2 up-regulation was positively associated with increasing concentrations of Gram-positive bacteria, whereas higher concentrations of Gram-negative bacteria, especially E. coli, caused a milder TLR2 expression increase compared with low doses. Cytokines were produced in similar dose-dependent profiles regardless of the stimulatory pathogen; however, Gram-negative pathogens induced higher cytokine levels than Gram-positive ones at same concentrations. These results indicate that Gram-positive and Gram-negative bacteria differ in their dose-dependent patterns of induction of TLR2 and TLR4, but not in cytokine expression.
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Citocinas/biosíntesis , Bacterias Gramnegativas/inmunología , Bacterias Grampositivas/inmunología , Receptor Toll-Like 2/biosíntesis , Receptor Toll-Like 4/biosíntesis , Regulación de la Expresión Génica , Bacterias Gramnegativas/genética , Bacterias Grampositivas/genética , Humanos , Inmunidad Innata , Monocitos/inmunología , Transducción de Señal/inmunología , Receptor Toll-Like 2/genética , Receptor Toll-Like 2/inmunología , Receptor Toll-Like 4/genética , Receptor Toll-Like 4/inmunología , Activación TranscripcionalRESUMEN
Bacterial meningitis (BM) remains an infectious disease with a significant morbidity and mortality. The aim of this study was to describe the kinetics of cerebrospinal fluid (CSF) cortisol levels during BM and to assess its relationship to disease severity and etiology. A total of 55 patients with BM were enrolled in the study. Elevated CSF cortisol upon admission and its rapid decrease after starting therapy were associated with increased BM severity as assessed by the Acute Physiology and Chronic Health Evaluation II score, the Sequential Organ Failure Assessment score, Glasgow Coma Scale score and the Glasgow Outcome Scale score. The comparison of CSF cortisol according to BM etiology revealed a trend toward higher concentrations in meningitis caused by Streptococcus pneumoniae compared to Neisseria meningitidis. Our results demonstrate that the initially elevated CSF cortisol concentrations decrease rapidly after administration of BM therapy (i.e. antibiotics and dexamethasone). Moreover, this rapid reduction of CSF cortisol was found in patients with high severity scores.
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Hidrocortisona/líquido cefalorraquídeo , Meningitis Bacterianas/líquido cefalorraquídeo , Meningitis Bacterianas/microbiología , APACHE , Antibacterianos/uso terapéutico , Antiinflamatorios/uso terapéutico , Dexametasona/uso terapéutico , Femenino , Escala de Coma de Glasgow , Escala de Consecuencias de Glasgow , Humanos , Cinética , Masculino , Meningitis Bacterianas/tratamiento farmacológico , Persona de Mediana EdadRESUMEN
We present the case of a 66-year-old female after renal transplant with severe course of herpes zoster (HZ). Although HZ represents a common infectious complication of transplant patients, its variable manifestation and ability to disseminate warrants serious consideration. Prompt diagnosis and treatment are essential in preventing further spread and disastrous complications.
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Herpes Zóster/etiología , Trasplante de Riñón/efectos adversos , Anciano , Femenino , Gangrena , Herpes Zóster/diagnóstico , Herpes Zóster/tratamiento farmacológico , Herpes Zóster/patología , HumanosRESUMEN
Biological treatment represents a significant progress in the therapy of many serious diseases. Together with the growing knowledge of pathophysiology and subsequent development of new therapeutic agents, this progress will definitely lead to further expansion of biologics. Since biologics interfere with many mechanisms of host defence, which may sometimes be compromised by them, increased risk of infectious complications must be taken into account. Patients treated with biologics are prone to classical virulent infections (e.g. listeriosis, legionellosis and tuberculosis) and opportunistic infections such as progressive multifocal leukoencephalopathy. Furthermore, suppression of the immune response that is caused by biologics may lead to reactivation of latent infections such as tuberculosis or viral hepatitis B. Therefore, the knowledge of basic mechanisms by which biologics modify the immune response is important for a rapid clinical diagnosis of possible aetiology of infectious complications.
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Anticuerpos Monoclonales/efectos adversos , Infecciones/inmunología , Humanos , Terapia de Inmunosupresión , Infecciones Oportunistas/inmunologíaRESUMEN
Reactivation, recurrence or acute infection with hepatitis B virus (HBV) represent severe complications of biological therapy. Reported is a case of a 58-year-old female treated in the past with cytostatics and rituximab for follicular lymphoma, in whom HBV infection was detected during a follow-up of the contacts of her partner diagnosed with acute viral hepatitis B. At the beginning, the patient had a very high serum level of HBV DNA (4.3 × 108 IU/mL) and therefore she was treated with combined antiviral therapy (lamivudine and tenofovir). After 10 months, the serum level of HBV DNA decreased significantly (3,100 IU/mL) and the combined antiviral therapy was switched to monotherapy with tenofovir. Another 5 months later, the serum level of HBV DNA was only 950 IU/mL. This case demonstrates important clinical problems connected with HBV infection in immunocompromised persons.