COVID-19's natural course among ambulatory monitored outpatients.

Research objective was to detail COVID-19's natural trajectory in relation to the Czech population's viral load. Our prospective detailed daily questionnaire-based telemonitoring study evaluated COVID-19's impact among 105 outpatients. In accordance with government quarantine requirements, outpatients were divided into a cohort with two negative tests at the end of the disease (40 patients) and a cohort with a new algorithm (65 patients) following a 14-day quarantine. Median follow-up differed significantly between the 2 groups (23 days vs. 16 days). Only 6% of patients were asymptomatic during the entire telemonitoring period. Another 13% of patients were diagnosed asymptomatic, as suspected contacts, yet later developed symptoms, while the remaining 81% were diagnosed as symptomatic on average 6 days following symptom onset. Telemonitoring enabled precise symptom status chronicling. The most frequently reported complaints were fevers, respiratory issues, and anosmia. Six patients were eventually hospitalized for complications detected early after routine telemonitoring. During the extended follow-up (median 181 days), anosmia persisted in 26% of patients. 79% of patients in the new quarantine algorithm cohort reported no symptoms on day 11 compared to just 56% of patients in the two negative test cohort upon first testing negative (median-19 days). The highest viral load occurred within 0-2 days of initial symptom onset. Both the PCR viral load and two consecutive PCR negative sample realizations indicated high interindividual variability with a surprisingly fluctuating pattern among 43% of patients. No definitive COVID-19 symptoms or set of symptoms excepting anosmia (59%) and/or ageusia (47%) were identified. No preexisting medical conditions specifically foreshadowed disease trajectory in a given patient. Without a PCR negativity requirement for quarantine cessation, patients could exhibit fewer symptoms. Our study therefore highlights the urgent need for routine ambulatory patient telemedicine monitoring, early complication detection, intensive mass education connecting disease demeanor with subsequent swift diagnostics, and, notably, the need to reevaluate and modify quarantine regulations for better control of SARS-CoV-2 proliferation.

Follow-up care after COVID-19 and its related concerns.

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (1). Overall COVID-19-related rates of mortality are low; deaths usually occur in patients older than 60 and those suffering from serious chronic diseases. Most of the patients recover within one or two weeks. However, in approximately 5-10 % of the patients some of the symptoms persist for weeks and months. Post-COVID-19 syndrome is a multisystem disease with overlapping symptoms and may occur even in patients who were relatively mildly affected during the acute phase of the disease. Evaluating the number of patients with or after the novel coronavirus infection in the Czech Republic, it can be estimated that in the next months there will be about 50,000 new patients suffering from long-COVID-19 requiring attention of general practitioners in the least, and, in all probability, also of other medical specialists. A thorough knowledge of the syndrome and efficient ideally evidence-based guidelines have to be formulated to combat the adverse impact of the pandemic.

[Guideline for the diagnosis and treatment of acute bacterial meningitis].

Acute bacterial meningitis is a severe infectious disease of the central nervous system. Its incidence decreases but lethality and sequelae remain high. The early initiation of appropriate treatment is a factor strongly determining the patient´s prognosis. The authors submit the Czech national guideline for diagnosis and treatment of community-acquired acute bacterial meningitis which has to provide clear and simple recommendations for clinicans involved in the care of meningitis in adults and children. The national guideline was based on the European guideline published in 2016 and adapted for the situation in the Czech Republic. It was acknowledged (approved? ratified?) by the Society for Epidemiology and Microbiology and the Society for Medical Microbiology of the Czech Medical Association.

[A sepsis caused by Capnocytophaga canimorsus: diagnostic and therapeutic options]. / Sepse vyvolaná bakterií Capnocytophaga canimorsus, moznosti diagnostiky a lécby.

The authors present a case report of a patient with sepsis caused by Gram negative rod Capnocytophaga canimorsus resulting from a dog bite. The infection had a course of septic shock progressing into multiorgan failure and serious ischemic damage to the extremities. The etiologic agent was identified utilizing molecular genetic methods and its detailed microbiologic characteristics are provided below. The report also outlines diagnostic and therapeutic options of this otherwise most likely under-diagnosed infection.

[Our experience with prevention of infection in patients post splenectomy.].

Splenectomy significantly impairs the immunity of the body; in a certain proportion of the patients this may cause the so-called OPSI (overwhelming post-splenectomy infection) syndrome, i. e. incidence of fulminant life-threatening infections. Even today, despite highly efficacious sophisticated antibiotics, this condition is burdened with very high mortality. In our paper we describe the management and preventive measures in splenectomized subjects at the Department of Infectious Diseases of the Teaching Hospital Brno.

[Marseille fever imported from Spain]. / Marseilleská horecka importovaná ze Spanelska.

The authors are presenting a case of young female with Marseille fever contracted in Spain. The clinical manifestation of the illness was characterized by fevers, exanthema, headache and a typical skin rash ("the black spot") and prompted the authors to strongly consider the diagnosis of Marseille fever and to initiate appropriate antibiotic therapy. The diagnosis was confirmed later by serology. The article introduces new taxonomy of Rickettsial species and presents an overview and epidemiological aspects of specific diseases caused by them. The clinical manifestation, diagnosis and treatment of Marseille fever are discussed in greater detail.