Francisella tularensis caused cervical lymphadenopathy in little children after a tick bite: Two case reports and a short literature review.

Although Francisella (F.) tularensis is a well-described and understood zoonotic pathogen, its importance in Central Europe is relatively minor and, as such, tularaemia may be missed in the differential diagnosis. The annual incidence of tularaemia in the Czech Republic is relatively stable with up to 100 reported cases per year, except in the epidemic years 1998 and 1999 with 225 and 222 reported cases, respectively. It is, however, higher in comparison with the neighbouring countries. The common route of transmission in Central Europe is handling infected animals. Tularaemia is not commonly recognized as a tick-borne disease. Here we report two rare cases of a tick bite-associated ulceroglandular form of tularaemia in 2.5-year-old and 6.5-year-old children presenting with cervical lymphadenopathy. The unusual and interesting features of those cases are the young age and relatively uncommon route of transmission suggesting possible changes in the epidemiology of tularaemia in the Czech Republic. Therefore, the infection with F. tularensis should be considered in the differential diagnosis after a tick bite even in infants.

Use of a new pneumatic system to support capillary microperfusion in surgical wound healing: an animal model.

OBJECTIVE: To test the efficacy of the a developed medical device, based on the principle of mechanical support of capillary microperfusion. METHOD: In this pilot study involving experimental animals, each pig had two standardised surgical wounds. A cuff that delivered pneumatic three-second micropulses was applied to the wound designated as the 'experimental wound'. The pressure inside the cuff was kept at a level <10mmHg so that during the pulse, the pressure would decrease by one third of the established value. The second wound, designated as the 'control wound', was covered with a standard dressing. Over the course of five days, the pressure inside the cuff was monitored. After the five days, the experimental animal was euthanised and two specimens were collected for histological analysis (one sample from each wound site). Wound healing parameters for the experimental and control wounds were examined by a pathologist. The level of statistical significance was set at 0.05. RESULTS: In this study, 10 experimental animals were used. The average pressure in the cuffs was 8.46mmHg (standard deviation: 3.86). No disparities in wound healing were observed in cases of different average pressures in the experimental wound. With respect to wound healing parameters, a statistically significant difference (p<0.05) was found in favour of the experimental wound. The occurrence of histological signs of poor healing was identical in both study wounds. CONCLUSION: The study shows that a device for the support of capillary microperfusion of the surgical wound had a positive effect. It was confirmed that the mechanical support system of capillary microperfusion was safe and reliable.

[Caring for women planning pregnancy or who are already pregnant: an infectious disease doctor's view].

The article discusses possible prevention and prophylaxis of infectious diseases affecting the course of pregnancy with respect to the mother, fetus and newborn. Also mentioned are diseases for which there is no vaccination. The options for prevention targeted at the periods before and during pregnancy and after delivery are explained. Finally, practical procedures related to vaccination and diagnosis of infectious diseases in women of childbearing age are presented.

[Concurrent malaria and rickettsiosis in a patient returning from the Republic of South Africa].

Definitive diagnosis and therapy proved challenging in the case of a 60-year-old male with malaria and rickettsiosis. Returning travellers who are unwell can present practical difficulties in diagnosis and treatment and the focus here is on conditions relevant to the Republic of South Africa. Malaria, rickettsiosis and Q fever are discussed.

Mapping of immunoreactive antigens of Francisella tularensis live vaccine strain.

Francisella tularensis subsp. holarctica is the common causal agent of tularemia in Europe. Besides clinical signs, the diagnosis of the disease mostly depends on serological tests. To date, there is a lack of information about the F. tularensis antigens that induce antibody response. Therefore, we have started comprehensive mapping of immunoreactive antigens using the attenuated live vaccine strain of F. tularensis LVS originating from the European virulent strain. For this purpose, the immunoreactivity of sera collected from patients suffering from tularemia, together with the control sera of patients with Lyme disease and healthy blood donors, were examined by means of one-dimensional and two-dimensional immunoblotting. Furthermore, whole cell bacterial lysates, isolated integral membrane proteins and basic proteins were exploited as antigens. By this approach more than 80 different immunorelevant antigens were detected. Most of them came from whole cell bacterial lysate and integral membrane proteins. Conversely, only a negligible reaction was found in the case of basic proteins. Forty-five spots were further selected for mass spectrometric analyses and 22 of them were annotated. Among the spots that provided characteristic reactions with sera from patients with tularemia, 60 kDa and 10 kDa chaperonins that occurred in several charge and mass variants, predominated.